Governor's Task Force on AIDS progress report

STATE OF ARIZONA
GOVERNOR'S TASK FORCE ON AIDS
DECEMBER 1990
PROGRESS REPORT
ROSE MOWORD
Governor
Governor
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Chair
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STATE OF ARIZONA
GOVERNOR'S TASK FORCE ON AIDS
December 11, 1990
The Honorable Rose Mofford
Governor of the State of Arizona
The State Capitol
Phoenix, Arizona 85007
Dear Governor Mofford:
I am pleased to deliver the Oversight Committee Report of your Task
Force on AIDS. This Committee began in January, 1990 to monitor
the State and community response to the comprehensive plan
generated by the Task Force on AIDS.
This report examines the legislative impact of HB 2173, the AIDS
Omnibus Bill as well as recommending future legislative strategies
that will further Arizona's response to HIV disease. The Oversight
Committee is pleased to report that HB 2173 represents a
progressive policy response for our state.
The analysis and recommendations contained in this report resulted
from extensive review and data collection from state agencies and
community based groups. The recommendations set forth in this
document further refine the 1989 Task Force Report.
The Oversight Committee recognizes that these recommendations are
very encompassing. In this document and the prior Task Force
Report we recommend a great deal, recommendations that will cost
money, and will change the response to HIV within the state of
Arizona. The Oversight Committee acknowledges that not all will
get done. This is a plan, a working document. We hope that policy
makers will respond to this plan and utilize what is feasible,
affordable and shape the response to HIV within this state.
3008 North Third Street, Phoenix, Arizona 85012 (602) 230-5818
The Honorable Rose Mofford
Governor of the State of Arizona
Date
Page 2
This document, when used jointly with the 1989 Task Force Report
represent both a long range strategy and evaluation of early
implementation of this plan. The task ahead is to continue to
evaluate and plan the implementation of these recommendations.
This will require additional input and the Committee has
recommended a HIV Planning Council to be an ongoing entity to
forward this process.
This report represents a tremendous amount of input from state
agencies, community based organizations, and citizens whose lives
are affected by HIV disease. Their work and contributions have
been invaluable to the work and progress of this Committee and I
thank them. We urge you to appoint an HIV Planning Council to work
with policy makers in Arizona, and to implement a state strategic
plan.
Sincerely,
' Jane Aiken
Chair Co-Chair
TABLE OF CONTENTS
PAGE
LETTER OF TRANSMITTAL ............................... i
LIST OF OVERSIGHT COMMITTEE MEMBERS .................... iii
I . EXECUTIVE SUMMARY ........................................ 1
I 1. OVERVOIEVWER SIGHT COMMITTEE ACTIVITIES ......................5 ............................. HIV AND AIDS IN ARIZONA 9
I11 . LEGISLATION
LEGISLATIVE SUMMARY AND RECOMMENDATIONS ............ 17
PROPOSED AIDS RELATED ADMINISTRATIVE RULES ......... 22
I V - COST DATA ANALYSIS
INTRODUCTION ....................................... 24 ANALYSIS ...........................................2 5
INSURANCE COVERAGE AND COBRA ..................... 25
1991 FEDERAL FUNDING ............................ .26
CSUPRERCETNRTU M CODFC FSUENRDVIINCGE S. ..........................................................23 71
MINORITY PROGRAM FUNDING ......................... 35
COMPREHENSIVE PLANNING ........................... 35
SUMMARY OF PROGRESS REPORTS
STATE AGENCIES ..................................... 39
COUNTY HEALTH DEPARTMENTS .......................... 63
V I , PRIORITY LIST OF OVERSIGHT COMMITTEE RECOMMENDATIONS
MINORITY ISSUES e m . . . . . . . . . . . . . m . . . . . . . . . . . . . . w . . . 67
GAY AND BISEXUAL MEN ............................... 76
HIV/AIDS AND CHEMICAL ADDICTION .................... 80
MENTAL HEALTH ...................................... 84
ADVANCES IN TREATMENT .............................. 87
INSURANCE .......................................... 90
WOMEN AND HIV/AIDS ................................. 91
CORRECTIONS ........................................9 6
CASE MANAGEMENT ................................... 100
LONG TERM CARE .................................... 104
FELLOWSHIP PROGRAM ................................ 107
RURAL AREAS ....................................... 109
COALITIONS ........................................ 112
V I I . RECOMMENDATIONS FOR HIV PLANNING COUNCIL 118
V I I I . APPENDICES
OVERSIGHT GOQRDINATING COMMITEE MEMBERS
JAN KENNEY, Co-Chair
8908 West Vogel Avenue
Peoria, Arizona 85345
(H) 878-5142
JANE AIKEN
Professor of Law
ASU School of Law
Tempe, AZ 85287
(0) 965-6463
(H) 966-6674
WAYNE AERNI
2545 East Garnet
Mesa, Arizona 85204
(0) 892-1525
RON BARNES
Arizona AIDS Information Line
1110 East Turney
Phoenix, Arizona 85014
(0) 234-2752
CHRISTOPHER BROWN
AIDS Program Coordinator
Pima County Health Department
150 West Congress, Room 334
Tucson, Arizona 85701
(0) 740-8315
RUDY BUST TE, M.D.
Deputy Chief of Pediatrics
Indian Medical Center
4212 North 16th Street
Phoenix, Arizona 85016
(0) 263-1200 (X1551)
CYNTHIA CHENEY RON., J . D .
Crampton, Woods, Broening and
Oberg
1122 East Jefferson
Phoenix, Arizona 85034
(0) 271-7722
BENNIE CLICK
Assistant Police Chief
phoenix Police Department
620 West Washington Street
Phoenix, Arizona 85003
(0) 262-6747
ELLOUISE COYNE
Sickle Cell Anemia Society of
Arizona
1818 S. 16th Street
Phoenix, Arizona 85034
(H) 561-0683 (0) 495-5193
JOHN DACEY
Attorney
Gammage & Burnham
2 North Central Avenue, 18th
Floor
Phoenix, Arizona 85004
(0) 256-0566
(H) 254-2580
SUE DODD, R.N.
Director
Arizona AIDS Project
919 North 1st Street
Phoenix, Arizona 85004
(0) 420-9396
MELVIN HARRISON
Central Navajo AIDS Coalition
Box 2164
Chinle, Arizona 86503
(0) 674-5223
SCOTT JACOBSON
Director of Community Affairs
Arizona Public Service
Post Office Box 53999
Phoenix, Arizona 85072-3999
(0) 250-2264
BETTY KERR
1035 West Fairway Drive
Mesa, Arizona 85201
(H) 969-7622
CHUCK MAYER
1027 East Halcyon Road
Tucson, Arizona 85719
(H) 293-6315
(0) 322-9808
JOHN MILLIKIN
Vice President
Motorola Corporation
5005 East McDowell Road,
Phoenix, Arizona 85008
(0) 244-3781
SHARON NELSON, R.N.
Cullen Building
Saint Joseph's Hospital
350 West Thomas Road
Phoenix, Arizona 85013
(0) 285-3955
(H) 843-4524
LINDA SIMMONS-PARSON
Project Coordinator
Greater Phoenix Affordable
Health Care Foundation
326 East Coronado
Phoenix, Arizona 85004
(0) 252-5890
ERNEST SIMON, M.D.
Executive Vice President
Blood Systems, Inc.
6210 East Oak Street
Scottsdale, Arizona 85252
(0) 946-4201
JULIA SOT0
Director of Patient Services
El Rio Santa Cruz Health Center
839 West Congress
Tucson, Arizona 85745
(0) 792-9890
DOROTHY TOMLIN
Director
Pinal County Health Department
188 South Main
Coolidge, Arizona 85228
(0) 723-9541
JULIE MARSHALL
AIDS Project Coordinator
3008 North 3rd Street
Phoenix, Arizona 85012
(0) 230-5818
GEOFFREY E. GONSHER
Special Assistant
Office of the Governor
State Capitol - West Wing
Phoenix, Arizona 85007
(0) 542-4331
LAURA MARISCAL
Clerk Typist I1
AMY BURGER
University of Arizona
Summer Intern
SHERRY ANDERSON
Secretary
THE GOVERNOR'S TASK FORCE ON AIDS
OVERSIGHT COMMITEE
EXECUTIVE SUMMARY
In December 1989, the Oversight Committee was formed. The charge
to the committee was to advocate for and evaluate the state and
community response to the comprehensive plan generated by the
Governor's Task Force on AIDS. The Oversight Committee's work
initially focused on advocacy for the passage of legislative bills
which supported the Task Force recommendations. The second half
of the work of the Oversight Committee was devoted to an evaluation
of the state's movement toward the recommendations made by the full
Task Force and identification of the obstacles to progress.
In the past year several important events have occurred to move
Arizona forward in implementing the strategic plan outlined by the
Task Force:
* Passage of HB 2173, the AIDS Omnibus Bill, which addresses a
broad range of areas including confidentiality, workman's
compensation, victim's rights, and insurance issues. This
bill represents a forward move for the state.
* Passage of HB 2352 which establishes expedited placement and
adoption for children with HIV disease.
* Regulatory proposals, to address implementation of HB 2173,
have been drafted by the Department of Insurance and the
Industrial Commission.
* The Department of Health Services passed rules and
regulations to ensure the continuance of anonymous testing and
emergency rules to address informed consent.
* The Department of Health Services has recently been awarded
funding to provide services in the area of home health care
for persons living with HIV disease.
* There has been a statewide growth in HIV/AIDS coalitions for
both coordination and seeking of funding.
* The majority of state agencies reported that HIV education
has either been undertaken or plans are underway to address
this area.
With the passage of the AIDS Omnibus Bill, Arizona is moving from
concerns about issues of confidentiality toward resource and
service concerns. During the past year the committee has noted a
decline in community based organizations nationally who have
provided care and prevention services for those affected by HIV.
The State of Arizona has also experienced this national trend with
the closure of three major community based HIV projects. The
Oversight Committee recommendations have identified three areas of
concentration forthe future of HIV policy and program development.
PLANNING FOR THE EFFECTlVE USE OF RESOUFUES
During the course of evaluating the agency and community response
to the 1989 Task Force Report the issue of planning repeatedly
emerged, especially as this planning focused on the use of
resources. This report outlines areas where planning and further
community input can be beneficial to the State of Arizona. These
areas include:
* Mechanisms to fund county health departments using criteria
that acknowledge the differences between regions of this
state and their need for HIV treatment and prevention
efforts.
* Effective program development to address HIV prevention and
treatment issues in ethnic minority communities.
* Programmatic development for specific needs and challenges in
addressing populations including gay/bisexual, women and
children, minority, drug and alcohol users, and chronically
mentally ill.
* Development of effective and compassionate services for
individuals living with HIV disease that require funding and
coordination by appropriate state agencies.
* Decreasing the over-reliance on federal funds through
additional funding from local, state, and private resources.
* Additional community input via work groups and Task Forces to
address specific areas including: development of an Office on
Minority Health, Advisory Committee of Law Enforcement
agencies, Case Management Work Group, and Long Term Care Task
Force.
To assist with the development of planning and coordination issues
the Oversight Committee has two clear recommendations that should
be given immediate priority. The first is the creation of an HIV
Planning Council to address policy and programmatic issues and the
implementation of the strategic plan. The second is to address the
area of state appropriations for HIV programs. Both of these
recommendations are critical to the development of programs and
plans to meet the future of Arizona's citizens whose lives are
affected by HIV disease.
IMPROVING EDUCATION AND PRRlENnON EFFORTS
The Task Force addressed the area of HIV school based education
last year with a mandatory HIV education bill. This bill was
amended to dilute the public health intent of the bill and
subsequently died in committee. The Oversight Committee believes
that this bill needs to be reintroduced during the next legislative
session.
Additionally, the AIDS Omnibus Bill contained language, as
originally drafted, that would have required mandatory one time
education for licensed health care professionals. This bill was
amended in the Senate and this section was deleted. The Oversight
Committee has heard from numerous individuals and groups that this
concept continues to be needed. The Oversight Committee believes
that this issue should be revisited.
The Oversight Committee has recommended development of education
that will reach rural health care providers, and provide a
consultative network for physicians to use.
In the area of education and prevention, there is a pressing need
for efforts directed toward specific populations, including
gay/bisexual men, women, adolescents, and IV drug users. The
committee heard from community groups who were developing new and
creative programs. New approaches include using consortium models,
outreach models, peer models, and empowerment models. The
committee also saw and heard about problems with lack of services,
lack of adequate funding, and lack of coordination. Education and
prevention efforts are crucial to the state in order to stop the
spread of HIV disease. Current prevention efforts in this state
rely mainly on federal funding. Such reliance is inadequate and
short-sighted. For every HIV case we are able to prevent now, we
will decrease the suffering and costs for many in our state.
ENSURING ADEQUATE ENT
Treatment and services for persons living with HIV disease
represent a concern reflected in both reports. Treatment issues
include the provision of appropriate services that are accessible
and provided by health care personnel who are HIV knowledgeable.
The committee recommends the following:
* Legislation that will provide for the state payment of COBRA
premiums to maintain private health insurance benefits. This
policy change should be examined and criteria developed that
will address this area for persons with catastrophic need
that includes but is not limited to HIV disease.
~r State funding for treatment and care provision. To not
provide treatment may prove more costly in the long run for
our state.
* Development of a fellowship program to address the needs of
physicians in gaining education and training in the treatment
of persons with HIV disease.
* Assurance that health care providers through the state AI-ICCCS
plans are HIV knowledgeable.
* Service coordination through a case management system has
proven efficacious in order to improve services and address
cost containment issues. Case management within this state
is in early development and further work, coordination, and
studies are recommended to advance this area.
The Oversight Committee Report has taken considerable time, effort,
and research to determine whether Task Force recommendations are
moving forward in both state agencies and the community. The
Committee received over forty written reports, as well as numerous
verbal reports, regarding the recommendations from the 1989 Task
Force Report. The committee is indebted to those individuals,
groups, and agencies who responded to the request for information
and data. The Oversight Committee is acutely aware of resource and
budgetary restraints faced by our state. Recommendations have been
developed to address resource and funding issues. The report
suggests further legislation, consideration of new policy areas,
program development, and service delivery systems. All
recommendations included in this Report were approved unanimously.
The Report has built upon the 11989 Task Force Report and this
report represents a further refinement of the initial
recommendations. The Committee, in not restating the original
recommendations, recognizes that the new recommendations do not
replace or de-emphasize the original report recommendations. This
report and the long term strategy outlined assist Arizona to move
forward in a cost-effective and compassionate manner to serve the
citizens whose lives are impacted by HIV disease.
OVERSIGHT COORDINATING COMMITEE
In November of 1989, the Governor's Task Force on AIDS submitted
a full report to Governor Mofford, which included over 100
recommendations addressed to state agencies, county health
departments and community based organizations. Upon acceptance of
the report the Governor selected a twenty one member Oversight
Committee to monitor the progress of the Task Force recommendations
addressed to State Government Agencies and other organizations.
The Committee was also charged with monitoring the status of
proposed AIDS legislation and producing a final progress report.
The committee membership includes thirteen members of the standing
Task Force and eight additional members who sewed previously as
resource people to the Task Force. The members were assigned to
participate in sub-committees, covering legislation, policy, and
costs.
The Oversight Coordinating Committee participated in a number of
important activities, including:
* The Junior League of Phoenix AIDS Symposium and luncheon,
with guest, former Surgeon General Dr. C. Everett Koop.
* The 1990 Legislative session supporting proposed AIDS
legislation recommended by the Governor's Task Force On AIDS.
* "Broadcasters Respond To AIDSw briefing organized by
Communications Technologies of San Francisco for the Phoenix
Chapter of the National Association of Broadcasters.
Oversight Coordinating Committee members took part in the
coordination of this event, and the panel discussion.
* The National Parents Council on AIDS, annual meeting, with
members of the Oversight Coordinating Committee as speakers
and panel participants.
* AIDS Coalitions, newly formed in response to the Task Force
report recommendations and concerns.
The Oversight Coordinating Committee worked closely with the
Department of Health Services, coordinating strategy and developing
position papers on proposed legislation. The committee also worked
with DHS to assure participation in the public hearings on DHS
rules regarding anonymous testing and school notification. The
Committee requested progress reports from state government
agencies, county health departments and community organizations.
The following progress reports were received from:
State Auencies
Arizona Health Care Cost Containment System (AHCCCS)
Department of Corrections (DOC)
Department of Economic Security (DES)
Department of Education (DOE)
Department of Health Services (DHS)
Department of Insurance (DOI)
Department of Public Safety (DPS)
Arizona Disease Control Research Commission
County Health Departments
Maricopa County HRSA Case Management System
Pima County HRSA Planning Project
Apache County Mohave County
Cochise County Navajo County
Coconino County Gila County
Greenlee County Pima County
Graham County Pinal County
La Paz County Santa Cruz
Maricopa County Yavapai County
Yuma County
Communitv Based Oruanizations
Arizona AIDS Information Line
Arizona AIDS Project (AAP)
Central Navajo AIDS Coalition
CODAC
Community Organization For Drug Abuse Control
CODAMA
Community Organization For Drug Abuse Mental Health And
Alcoholism Services
Concilio Latino De Salud
COPASA
Community Outreach Project On AIDS In Southern Arizona
Greater Phoenix Affordable Health Care Foundation (GPAHC)
Hemophilia Association
Indian Community Health Services
Inter Tribal Council Of Arizona
Junior League Of Phoenix
National WARN Project
People with AIDS Coalition of Tucson
Phoenix Shanti Group
Phoenix Urban League
Planned Parenthood Of Central And Northern Arizona
Planned Parenthood Of Southern Arizona
Tucson AIDS Project (TAP)
Tucson Minority Consortium
University Of Arizona AIDS Education Program
During the review of progress reports and identification of work
accomplished by both state agencies and community based
organizations the Oversight Committee selected thirteen priority
areas for additional attention. This does not represent a de-emphasis
of the other recommendations in the 1989 Task Force
report.
The Oversight Committee acknowledges that their first six months
of work focused, by necessity, on the passage of House Bill 2173
and the legislative process which required a concentrated effort
by Oversight Committee members and a broad base of community
representation.
The Oversight Committee worked in groups to refine those areas
covered in this report in order to develop further recommendations.
Additional information was gathered by committee members who
personally contacted or worked with state agencies and community
based organizations to ensure accuracy of facts represented in this
report. The Oversight Committee worked throughout the summer to
gather and analyze information for the report. The Committee of
the whole met twice in the fall to review the documents and
recommendations. Final recommendations, after revision, were voted
on by the Committee. Committee members unanimously approved
recommendations. The Report recommendations represent the critical
concerns addressed by the Committee during the past year.
Oversight Coordinating Committee
February 1990 - October 1990
Meeting Schedule
Office of the Governor
1700 West Washington Street
Phoenix, Arizona
8th Floor Conference Room
February 9, 1990
March 9, 1990
April 11, 1990
Basement Conference Room
May 9, 1990
June 13, 1990
September 12, 1990
September 26, 1990
October 2, 1990
Arizona Department of Health Services
1740 West Adams
Phoenix, Arizona
Conference Room A, Fourth Floor
October 16, 1990
HIVIAIDS IN ARIZONA
The HIV and AIDS epidemic continues to worsen in Arizona. A total
of 1,262 cumulative cases of AIDS had been diagnosed and reported
in Arizona by October 1, 1990. An additional 363 cases of AIDS
Related Complex (ARC), 2,482 identifiable HIV-positive test
results, and 601 anonymous HIV-positive test results (anonymous HIV
tests are not included statistically with confidentially reported
HIV tests in order to avoid duplication) had been diagnosed and
reported by October 1, 1990. Overall, 60 percent of Arizonans
diagnosed with AIDS have died.
Although some leveling of the rate of the initially exponentially
increasing epidemic has been seen, each year's annual AIDS cases
continue to exceed those of the previous year. In 1989, 308 new
cases of AIDS were diagnosed, compared to 279 cases in 1988 and 255
cases in 1987.
Arizona continues to rank 22nd among states in the total number of
AIDS cases: however, Arizona's AIDS case rate over the past year
(September 1989 - August 1990) of 10.5 per 100,000 population
exceeds those of some other states with greater cumulative numbers
of AIDS cases such as Illinois (9.7 per 100,OOD) and Pennsylvania
(9.6 per 100,000). Over the same time period, the rate per 100,000
population in metropolitan Phoenix (13.5) and Tucson (9.6) compare
remarkably to large urban areas often thought of as having a
significant AIDS caseload such as Chicago (15.1) and the suburbs
of Los Angeles of Anaheim (15.1) and Riverside/San Bernardino
(10.3). These rates in Phoenix and Tucson exceed the rates seen
in the urban cities of Detroit (8.5) and Pittsburgh (6.8) . The
most current rate of 13.5 per 100,000 population in Phoenix exceeds
the annual case rate of 11.6 per 100,000 seen in Los Angeles during
the calendar year 1985, less than five years ago.
The largest concentration of diagnoses of AIDS occurs in the 30-39
year age group. National studies indicate that the average length
of time from infection with HIV to development of AIDS is 10 years
or longer. Thus, it is not surprising that the highest
concentration of diagnoses of ARC and asymptomatic HIV infection
include individuals in their twenties as well as their thirties.
AIDS cases continue to be overwhelmingly male. The male-to-female
ratio of AIDS diagnoses is 24 men to 1 woman in 1989. Fewer women
were diagnosed with AIDS in 1989 as compared to 1988. Women
represent about 10 percent of the HIV asymptomatic cases reported.
Of women who are HIV infected about half report IV drug use as the
risk factor and one third report heterosexual contact. Since 77
percent of all women reported with HIV infection are between the
ages of 20 and 40 potential exists for perinatal HIV infection in
this group.
The following Fisure 1 examines HIV cases, including ARC and AIDS,
by risk behavior:
ARIZONA HIV INFECTIONS
BY TRANSMISSION GROUP
Transmission Group AIDS
--
Gay or Bisexual Men 823
IV Drug User 94
Gay/lV Drug User 134
Hemophiliac 2 1
Heterosexual Contact 29
Transfusion with Blood 49
Parent at Risk or w/HIV 3
Other/Unknown 49
- --
TOTAL 1203
ARC HIV+ TOTAL (%)
* 24% had unknowdother risk, not included in (%)
As of 06/30/90 ADHS orfios of HIV/AIDS Services
FIGURE 1
Of the 1,262 AIDS cases, 1,066 (84 percent) were White, compared
with 126 (10 percent) Hispanic and 50 (4 percent) Black. Using
1980 census data, these represent cumulative rates per 100,000
population of 52.6 among Whites, 28.6 among Hispanics, and 68.2
among Blacks. Importantly, the AIDS incidence rate among Blacks
has been increasing rapidly in relation to rates among Whites and
Hispanics.
Arizona AIDS cases when evaluated for risk behaviors found within
ethnic categories shows: Fiaure 2
ARIZONA AIDS CASES: PERCENTAGE
BY RISK BEHAVIOR WITHIN RACE/ETHNICITY
WHITE BLACK HISPANIC
N = 1015 N = 48 N = 121
n GAY/BISEXUAL n IV DRUG ABUSE
TRANSFUSION GAY/IVDA
As of 06/30/90 OTHER ADHS Office HIVIAIDS Servtces
FIGURE 2
This data is significant due to the changes in the risk behavior
of IV drug use and gay/bisexual. Fully one fourth of Blacks with
AIDS report IV drug use as the probable mode of transmission,
whereas Hispanics report 12 percent and whites report 6 percent.
Obviously there is a implication for outreach and intervention.
The following Fisure 3 summarizes HIV infections by Race/Ethnicity:
Arizona HIV Infections
Race Specific Rates
By Year of Report
RATE PER 100,000 POP.
WHITE BLACK HISPANIC NATIVE AMERICAN ASIAN
RACE\ETHNICITY
*As of 07/31/90
FIGURE 3
Geographically, the largest concentration of AIDS cases continues
to be in Maricopa County, followed by Pima County. However, all
counties have reported at least one case of AIDS. The following
Table 1 and Figure 4 summarize data reflecting the impact of AIDS
on the counties within Arizona. Maricopa County continues to
report increases in numbers of AIDS cases.
ARIZONA HIV INFECTIONS
By County of Residence
COUNTY AIDS ARC HIV TOTAL
APACHE 5 1 2 8
COCHISE 9 6 42 57
COCONINO 8 - 15 23
GILA 4 - 3 7
GRAHAM 3 2 3 8
GREENLEE - - - -
LA PAZ 3 1 6 10
MARICOPA 891 295 1514 2700
MOHAVE 11 - 24 35
NAVAJO 4 - I 5
PIMA 222 35 475 732
PINAL 11 2 22 35
SANTA CRUZ 2 1 3 6
YAVA PA I 13 - 22 35
YUMA 15 5 49 69
UNKNOWN 2 6 289 297
TOTAL 1203 354 2471 4028
As of 06/30/90 ADHS Office of HIV/AIDS Services
TABLE 1
Arizona AIDS Cases
Cases by Rural and Metropolitan Counties
by Year of Diagnosis
Cases
MARlCOPA PlMA RURAL UNKNOWN
As of August 31, 1990 ADHS Office of HIV/AIDS Services
FIGURE 4
Homosexual and bisexual men have continued to comprise a majority
of reported AIDS cases in Arizona (see Figures 1 and 5). HIV
seropositive case data reported to the Arizona Department of Health
Services (ADHS) suggest that this trend will continue, since
homosexual and bisexual men comprise 71 percent of those reported
with asymptomatic HIV infection (see Figure 2 and Figure 5).
AIDS cases diagnosed among intravenous drug users have been
increasingly reported. In 1988, 12 percent of all cases claimed
intravenous drug use as their sole risk behavior. This compares
to 6 percent claiming the same in 1985. This increase raises
concerns that increasing HIV infection among intravenous drug users
may accelerate the spread of HIV infection into the heterosexual
population. Data from an on-going blinded HIV seroprevalence
study, being conducted by ADHS in two Phoenix drug treatment
centers, indicate that the current level of HIV infection among
intravenous drug users seeking treatment is low, around 3 percent.
Similar studies in New York and New Jersey have found much higher
rates among intravenous drug users, some in excess of 50 percent.
This suggests that timely prevention efforts among intravenous drug
users may avoid high infection rates.
Arizona HIV Infection
Percentage by Risk Behavior
and Year of Report
Percent
1
-
Gay Gay/lVDU IVDU Blood* Hetero Other Unknown
Risk Behavior
Includes hemophilia and transfusions
AS of 07/31/90 ADHS Office of HIVIAIDS Services
FIGURE 5
Utilizing estimates and projections of the Centers for Disease
Control, and comparing local HIV seroprevalence rates to other
regions of the country in this regard, the Arizona Department of
Health Services (DHS) has made estimates and projections for
current and future cases of HIV-related disease in Arizona.
Currently, DHS estimates that approximately 10,000 -20,000
Arizonans are infected with HIV. By the end of 1993, DHS expects
a cumulative total of 3,120 - 3,840 Arizonans to have been
diagnosed with AIDS.
Given the level of HIV infection already present in the community,
and the long time course from infection to AIDS, Arizona will
continue to feel the effects of HIV-related disease for many years
to come.
LEGISLATIVE SUMMAFW AND RECOMMENDATIONS
BACKGROUND
Arizona's Legislature considered nearly a dozen bills during the
1990 spring session which dealt with issues directly affecting HIV
infected persons or directed toward preventing further spread of
the disease. One bill, House Bill 2173, researched and drafted by
the Task Force and sponsored by Representative Susan Gerard, was
signed into law in June 1990. Another House Bill, HB 2352,
provided for expedited placement and adoption of HIV positive
children, was signed into law by the Governor in April 1990. The
remaining bills considered by the Legislature all failed ultimately
before reaching the Governor's desk.
AIDS OMNIBUS BILL
House Bill 2173, frequently referred to as the AIDS Omnibus Bill,
addresses a variety of public health and social policy issues.
The Omnibus Bill creates a statutory structure for maintaining the
confidentiality of public health and other medical records and
promotes voluntary testing by mandating an anonymous testing
option. Testing is also encouraged by requiring informed consent
for an HIV test and for release of HIV related insurance records.
The worker's compensation portion of the bill establishes a
procedure which assures health care workers and others who acquire
HIV infections in the course of their employment, that worker's
compensation benefits will be available. The Omnibus Bill gives
victims of sexual assault and other crimes where there is a
potential for infection the right to access the convicted
offender's HIV test results. Other provisions aimed at further
reducing the spread of the disease include new statutory authority
for the Department of Health Services to establish procedures for
controlling infected persons who cannot or will not conform their
own behavior for the protection of others. The Omnibus Bill also
incorporates portions of a separate bill, SB 1044, which authorizes
the Director of Insurance to adopt rules concerning the
confidentiality of HIV information in the insurance setting. This
section of the Omnibus Bill also requires written informed consent
for HIV testing done during the insurance application process.
The new AIDS Omnibus Bill does not solve every problem or deal with
every medical issue related to the HIV epidemic. Nonetheless, the
State of Arizona has taken a large step toward aggressive,
comprehensive policy for dealing compassionately and intelligently
with HIV infected persons and protecting those who are not infected
from the disease. Perhaps more importantly the creation of this
bill proves that fair-minded, well-informed people from markedly
disparate sociopolitical perspectives can work together and reach
a consensus on how to combat the threat of HIV.
The Interaovernmental Health Policy Proiect. AIDS Policy Center at
Georae Washinuton University reports on significant and exemplary
AIDS-related program and policy initiations occurring within state,
county and municipal governments nationwide. During the summer of
1990 the project provided the Oversight Committee with this
analysis:
The AIDS Omnibus Bill is a remarkable accomplishment for the State of
Arizona. Arizona was one of the very few states that were able to take a
comprehensive approach to HN issues and pass omnibus legislation. Prior
to this legislative session, Arizona had lagged in its ability to cope with the
myriad problems associated with AIDS. The Act brought Arizona into the
mainstream with its legislative strategy for dealing with HN disease.
Arizona is now one of twenty states which require data in medical
treatment records to be confidential. Arizona is one of forty-four states with
worker notification laws and one of eighteen states that provide for some
kind of partner notification when there appears to a physician that there is
a need to warn such parties. The plan that Arizona developed is unique in
that it uses the expertise of the health department as a control so that such
notification is done sensitively and with minimal breach of confidentiality.
Arizona has instituted innovative insurance laws. It is one of sixteen states
that require informed consent before insurance HIV testing and one of
nine that require confidentiality provisions in insurance. Additionally,
Arizona is one of three states that has passed a law that will allow the
accelerated use of life insurance benefits. Clearly this legislation is a major
step forward in our fight against HN disease.
OTHER BILLS SUPPORTED BY TASK FORCE
The Task Force prepared two other bills which would have helped
stop the spread of AIDS, but neither of these bills survived
legislative scrutiny. House Bill 2361 would have required public
schools to include age appropriate information about AIDS in
health class curricula. Educating Arizona's children about AIDS
is one way the members of the Task Force agreed would protect the
next generation of adults from the risk of contracting HIV
infection. This bill passed the House of Representatives but was
amended by the Senate in such a way that the public health benefits
of the bill were eliminated. The AIDS school instruction bill did
not pass the conference committee.
Another bill recommended by the Task Force, HB 2222, did not deal
specifically with AIDS, but provided protection from discrimination
for all disabled Arizonans, This bill would have mirrored the new
federal Americans with isa abilities Act which expands legal
protection against discrimination in employment, transportation,
public accommodation and telecomunications for the disabled.
Preventing discrimination against disabled people, including those
with HIV infection, was another key recommendation made by the Task
Force for the purpose of encouraging voluntary testing.
Public health authorities, including former Surgeon General Koop,
have repeatedly stated that providing protection from
discrimination will have the positive public health benefit of
encouraging those who are infected to obtain testing and learn how
to protect others from infection. During the Task Force's final
deliberations on its recommendations to the Governor, the
representative fromthe Arizona Attorney General's office indicated
that the Attorney General would support precisely this type of
legislation to benefit HIV infected and all other disabled persons.
The Attorney General's office did not actively support this bill
when it was submitted to the House of Representatives.
A fair housing bill, Senate Bill 1150, was created independent of
the Governor's Task Force on AIDS. This bill would have provided
some protection from discrimination for disabled people, including
those who are HIV infected. Unfortunately, this bill, too, did not
pass committee. House Bill 2264 which introduced payments of COBRA
for persons diagnosed with AIDS was introduced and after a hearing
the Committee was referred to the Joint House and Senate Hearing
Committee.
BILLS NOT SUPPORTED BY TASK FORCE
Four other bills concerning AIDS issues were introduced during the
spring session but received little legislative support or
attention. House Bill 2128 would have required physicians to
attend continuing medical education concerning the benefits of
autologous blood donations. House Bill 2129 would have allowed
mandatory testing on persons accused but not convicted of sexual
offenses. HB 2330 (Senate version was SB 1304) would have mandated
testing of all prisoners and regulated certain aspects of applying
for health insurance. None of these bills were supported by the
Task Force because the AIDS Omnibus Bill dealt more completely and
effectively with these issues. In addition, certain aspects of
these three bills, particularly the mandatory testing provisions
of HB 2129, would have a negative effect on public health policies
and strategies designed to increase voluntary testing and decrease
the number of new HIV infections.
RECOMMENDATIONS
ANALYSIS: The Oversight Committee of the Task Force has four
primary recommendations for legislation in the upcoming legislative
session. Two of these are the same recommendations originally made
by the Task Force:
Age appropriate AIDS education in the public schools, as part of
the health cussiculum, is essential to protect the next generation.
Protection of disabled people from discrimination in the most basic
areas of daily life (employment, housing, transportation, public
accommodation, and telecommunications) is essential to the success
of public health efforts to test everyone at risk for HIV and
provide those who are infected with the information they need to
protect others from acquiring the infection.
The Oversight Committee has identified two more critical areas in
which legislation is needed. The Legislature must appropriate
funds to implement the public health strategies for prevention of
HIV infection. Education remains the most successful tool in
reducing the risk of acquiring HIV infection. Some important
aspects of education can be accomplished without significant funds.
For instance, HIV-related information can be added to school based
health programs. While funding will be required for other
programs such as outreach educational programs for drug addicts,
high school drop outs, and other people, many of them teenagers,
who cannot be reached through established institutions such as
schools or churches.
~ppropriation of funds is also significant in light of the Ryan
White federal legislation. This piece of legislation addresses two
major areas of funding that will impact Arizona: 1) Coordinated
direct services for AIDS, ie, case management, home and community
services and 2) Counseling, testing and early intervention.
The other area where legislation is urgently needed is in providing
adequate medical services for people with AIDS and other
chronically ill, uninsurable Arizonans. One relatively simple and
highly cost effective measure would be to adopt legislation which
allows the State to pay private health care insurance premiums.
This would ensure that those persons who qualify for COBRA will
receive medical care under a private insurance policy rather than
entirely at the expense of Arizona's indigent health care program.
The payment of COBRA premiums to continue private insurance should
be examined in a broader based model where catastrophic illness
criteria can be developed. To limit this program to AIDS is not
in the best interests of Arizona. Similar programs have been
developed in Texas, Connecticut, and California
There is no doubt that other appropriations will be necessary to
provide medical care and treatment for persons infected with the
HIV virus. The problems faced by people with HIV disease who do
not have private health insurance must remain a high priority for
the legislature. Allowing the State to take advantage of private
insurance policies available to some persons with HIV disease is
an important first step in solving those problems.
THE OVERSIGHT COMMITEE RECOMMENDS:
1. Reintroduction of a mandatory K-12 HIV education bill.
2. Reintroduction of a bill preventing HIV related discrimination
in employment, public accommodations, transportation and
housing.
3. Introduction of an Appropriations Bill to fund programs in
the areas of HIV prevention and direct care provision for
persons with asymptomatic and symptomatic HIV disease.
4. Introduction of a bill to continue payments to maintain
private insurance coverage. Criteria for eligibility should
be based on both fiscal need, uninsurable status, and
chronic/catastrophic health problem.
PROPOSED AIDS RELATED ADMINISTRATIVE RULES
DEPARTMENT OF HEALTH SERVICES
Initiated the process to amend administrative rules regarding
anonymous HIV testing, notification of school districts of HIV-infected
pupils, and confidentiality of communicable disease
information in November, 1989. The amendments regarding anonymous
HIV testing and confidentiality were necessary to continue the 18-
month emergency measures implemented by DHS in March 1989. DHS
held public hearings in June 1990 to address proposed rules on
anonymous testing, school notification and confidentiality. The
proposed rules were not drafted in concert with the proposed
legislative House Bill 2173. These rules were filed by the
Secretary of State on September 14, 1990. The Governorts Task
Force on AIDS, county health officers, medical and hospital
associations were notified of the conflicts by DHS and directed to
adhere to the provisions of the statutes in any conflicting areas.
(see Appendix 1)
At the time of the public hearing HB 2173 passed the Senate prior
to the last public hearing scheduled in Phoenix. For the public
record the Chairperson of the Oversight Committee requested a
response regarding the impact of the statutes on the proposed
rules. The response received indicated that although the rules
needed to be revised based on HB 2173 the rule making would
proceed.
Based on this response the Oversight Committee legislative
subcommittee met and reviewed the Rules and the process of rule
making. A letter to DHS dated August 8, 1990 addresses three major
areas where the rules are inconsistent, and in fact are over ridden
by HB 2173 (see Appendix 2). This letter summarizes the Oversight
Committee concern with the proposed rules. DHS responded to the
Oversight Committee letter in a letter August 23, 1990 (see
Appendix 3). The rules promulgated are in some places inconsistent
with the law and must be redrafted and put through the rule making
process. These rules were approved on September 14, 1990. DHS has
also promulgated a 90 day emergency rule detailing procedures for
obtaining specific, written and informed consent before HIV
testing. DHS is currently drafting rules for HB 2173. Hearings
should be held in the spring.
DEPARTMENT OF INSURANCE
Is promulgating rules currently. The rules will consist primarily
of the Department's current "AIDS guide lines^^ but will include
some additional modifications as may be required by the new law.
INDUSTRIAL COMMISSION
Is promulgating rules specific to the Workers Compensation
provisions of the law. They are currently gathering information
about necessary content of these rules. At this time the Oversight
Committee has indicated both the desire and willingness of members
to work with DHS on the proposal and drafting of rules for HB 2173.
COST DATA ANALYSIS
INlRODUCTloN
The costs of HIV disease not only affects specific government
agencies, hospitals, and insurance companies, but has an effect on
all aspects of society. Everyone will share the burden of the
costs of AIDS. The potential numbers in Arizona are truly
alarming:
~r The 1989 Report of The Governor's Task Force on AIDS included
a ten year forecast projecting that HIV/AIDS could cost
Arizona's health care system up to $750 million with the
state paying $225 million in direct costs for HIV disease
related health care.
* A 1989 study for AHCCCS completed by the ASU School of Health
Administration stated that total costs for treatment of
persons with HIV Disease to AHCCCS through 1992 range from
$24.6 million to $42.2 million. At the time of the report
AHCCCS was responsible for over 50% of all AIDS cases
reported.
* Local and national projections of AIDS cases indicate that
annual numbers of AIDS cases will continue to increase through
1993.
* Gathering accurate numbers and cost figures for HIV disease
in the state is a difficult task, making the development of
a long range plan even more uncertain.
The trend is obvious, ever increasing new HIV/AIDS cases,
increasing burdens on our state and local health agencies, our
hospitals and community based organizations. Arizona is considered
a second wave state, with other states such as California and New
York considered first wave states. This means that Arizona will
soon face similar strains to its health system. In fact major
cities in California and New York have been declared health care
"disaster areasw by Congress, thus qualifying them for desperately
needed special federal funds. Although the numbers are indeed
grim, many of these devastating costs can be avoided if a
coordinated long term strategy to deal with HIV disease in Arizona
is developed. There are several steps that if taken now can save
millions of dollars in the future.
ANALYSIS
INSURANCE COVERAGE AND COBRA PAYMENT8
Large numbers of persons with HIV disease are without health
insurance and eventually require state agency assistance at
significant expense to the state. Several states have undertaken
programs to assist not only HIV infected persons but other citizens
in maintaining private insurance. These states have found this to
be a cost effective and efficient way of allowing individuals to
receive medical treatment. One option being tried by states is a
program where the state pays health insurance premiums under the
COBRA plan. The COBRA plan allows an individual who has lost a
job to maintain at their own expense private insurance for a
minimum of 24 months. Frequently the person is unable to maintain
the insurance premiums due to fiscal problems and loses health
insurance coverage. When a major illness occurs, the individual
is unable to pay for the treatment eventually a state agency pays
the cost or it is picked up as charity care. With AIDS and other
serious illnesses this can create a tremendous burden not only on
the state health care budget, but also contributes to the growing
problem of uncompensated health care which threatens the financial
life of many community hospitals. If an individual qualifies under
this alternative program, the state pays the private insurance
premiums until the individual is able to once again pay their own
premiums. Although these programs are new, there are initial
indications that these alternatives are very cost efficient.
1. The state of Washington estimates $3.25 million in savings for
the fiscal year 1991, with $1.6 million saved in 1990. The
costs of care for persons with AIDS is $1,981 monthly, while
the average insurance premiums cost $150 per month.
2. The state of California has preliminary estimates of savings
of over $750,000 for the first five months of 1990.
3. Other states have just begun the program, with each state
setting up eligibility standards based on either total family
assets (usually less that $10,000) or a percentage of federal
poverty guidelines.
The Ryan White Act contains a provision for payment of COBRA to
maintain health insurance coverage. The Oversight Committee
recommends the payment of COBRA premium as an alternative to
maintain private health insurance. The costs of paying the private
insurance premiums for citizens far outweigh the costs of having
the state pay for expensive medical treatment. The growing number
of uninsured citizens who need medical care but have no health
insurance is a tremendous strain on our health care system in
Arizona. This problem will only be worsened by the increasing
number of persons with HIV disease who require expensive long term
medical treatment. It is in the interest of the state and the
taxpayers to see that every effort is made for these individuals
to maintain or have available private health insurance.
Implementing a program to assist these individuals is an
inexpensive alternative that can save the state dollars.
1991 FEDERAL FUNDING
During 1990 the Congress passed two significant pieces of
legislation. These Acts will affect the future federal funding
allocations available in Arizona as follows:
HEALTH OMNIBUS PROGRAMS EXTENSION (HOPE) ACT: In 1988 federal
changes authorized AIDS prevention funding on a formula basis
rather than a competitive basis. Since 1986 CDC has provided
funds through cooperative agreements to state health
departments. During 1990 the HOPE legislation failed to gain
an appropriation. Arizona was one of thirty five states who
would have faced decreased funding under the formula based
funding proposed. The proposed formula would have decreased
Arizona funding by approximately 20 percent. HOPE formula
funding was based upon the state's relative number of AIDS
cases and relative percentage in the total U.S. population.
This legislation would have effected the funding for program
categories including health education, minority initiatives,
public information programs and school based programs.
RYAN WHITE COMPREHENSIVE AIDS RESOURCES EMERGENCY ACT OF 1990:
The White legislation provides federal support for
comprehensive health and social services for people living
with AIDS and HIV disease. There are four areas of this ACT:
Title I provides emergency relief grants to meet the out-patient
and case management needs identified by planning
councils in localities disproportionately affected by the HIV
epidemic (does not include Arizona but covers 16 cities).
Title I1 provides grants to states for care consortia and
other programs to improve and increase availability to HIV
services. This title is an area where Arizona may apply for
funds in the following areas:
1. Establish HIV care consortia for a comprehensive system
of HIV services.
2. Provide hame and community based care services for
persons with HIV disease.
3. Provide assistance to assure continuity of health
insurance coverage for persons with HIV disease.
4. Provide treatment to economically disadvantaged persons
with HIV disease, including outreach to identify these
persons.
Title 111 provides grants to states and public/private
nonprofit clinics receiving grants administered by HRSA for
HIV antibody counseling and testing, diagnostics, and early
intervention treatment and referral. Arizona will be eligible
to apply for this funding along with HRSA administrated
clinics. In the future this funding may take over for current
CDC HIV antibody testing and counseling monies and expand the
area of early intervention.
Title IV is a broad area containing a number of provisions
including Pediatric AIDS research demonstration, special
studies, and provisions for emergency response employees.
Appropriations for the Ryan White Act were passed by Congress
in late October for $226 million, with no forward funding
beyond FY91. This amount is far less than the original
authorized amount of $881.5 million. Funds appropriated do
not fund Title 4 of the Act but Titles 1, 2, and 3. It is too
early to determine the impact of this appropriation on future
Arizona funding.
SPECTRUM OF SERVICES AND COST OF PLANNING
The continuum of care for HIV disease ranges from asymptomatic
wellness based care to acute care, chronic care, and terminal care.
Although the Oversight Committee requested information from AHCCCS
regarding cost of care for their clients with HIV the data was not
available at the time this report was drafted. It is estimated
nationally that Medicaid systems are the responsible payor for 50-
60% of all chronic and terminal care by national reports. Although
the bulk of money spent on home care comes from Medicare, few
persons with AIDS qualify for Medicare.
In order for Arizona to be diligent in addressing both the spectrum
of services and cost of planning to provide these services, there
must be an effort to correlate and study in-state data. AHCCCS is
a key player since they have current data and are heavily affected
by potential costs. Research and evaluation should address:
* What are the current and projected needs, demands,
utilization patterns and costs of the components of HIV care
on a continuum?
* Can longitudinal studies of cohorts of HIV-infected
individuals be developed to identify ranges of services and
resources needed and utilized?
* How can case management systems impact accessibility,
quality, and cost of care issues?
* What is the projected effect of early intervention treatment
and monitoring on the course of HIV disease?
* What are the comparative cost and outcomes of care in
respective community settings and how do these compare with
institutional settings?
This represents the foundation for building a strategic plan for
addressing HIV/AIDS research in Arizona. In order to accomplish
this review and research, leadership must emerge. Likely leaders
within the state include AHCCCS and University of Arizona Health
Sciences Center.
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS)
Although AHCCCS was unable to complete cost data analysis on
enrollees with HIV disease by the deadline for this report they
were able to examine trends in enrollment and provider health plan
data.
Since January 1989, over the past 18 months,, enrollment of persons
with HIV disease in AHCCCS has doubled. This is reflected in the
number of cumulative patients enrolled monthly with AIDS. Fiqure
-1 shows the total numbers of AIDS patients served by AHCCCS (N =
700). For accuracy one must subtract the total deceased patients
(N = 308). Currently AHCCCS reports 154 person who are inactive
or not eligible for services. A portion of these may simply
require renewal of enrollment.
AHCCCS - TOTAL AIDS PATIENTS
CUMULATIVE REPORTED MEMBERS
J 8 9 F M A M J J A S O N D J 9 0 F M A M . J J A
SINCE 1989
OFFICE OF THE MEDICAL DIRECTOR
FIGURE 1
Fisure 2 indicates where persons with AIDS are enrolled for health
care. There are five major health plans who play a significant
role in provision of services. These are identified in the
following chart:
AHCCCS - AIDS ENROLLMENT
AS OF SEPTEMBER 1, 1990
I BY HEALTH PLAN I
MERCY
OFFICE OF THE MEDICAL DIRECTOR
FIGURE 2
As of September 30, 1990 the Arizona HIV Infection Surveillance
Report shows:
Number of AIDS cases
to 9/30/90
Number of AIDS cases
reported deceased
Number of AIDS cases
(excluding deaths)
Number of AIDS cases
(living) enrolled in
AHCCCS as of 9/1/90
AHCCCS data reflects 46 percent of persons diagnosed and reported
in Arizona with AIDS utilizing their services. This does not
include persons with symptomatic or asymptomatic HIV disease.
Additionally, not all AHCCCS cases are cases reported within
Arizona. It is clear based on this data that AHCCCS is a
significant provider of health care whose role is increasing
rapidly as demand for care increases.
CURRENT STATE FUNDING
Current appropriation to DHS for AIDS from the State of Arizona is
approximately $487,200. These funds are used to provide staff
positions to DHS and to contract funds to Maricopa and Pima
Counties for AIDS surveillance. DHS staff positions include:
Office of AIDS Manager; Public Health Nurse Consultant;
Statistician; Health Educator I; and Clerk Typist. The use of
these funds in FY 89/90 is summarized in Table 1:
ARIZONA DEPARTMENT OF HEALTH SERVICES
STATE FUNDED AIDS BUDGET*
JULY 1, 1989 - JUNE 30, 1990
Personnel $113,400
Fringe Benefits 30,000
In-State Travel 5,500
Out-of-State Travel -------
Other Operating 213,300
Equipment -------
Contractual 125,000
TOTAL $487,200
TABLE 1
No state funds are contracted for either HIV prevention or
education programs
$125,000 is subcontracted to Maricopa and Pima Counties for
surveillance activities.
The total Arizona State dollars is $487,200 (FY 89/90). Total
CDC dollars is $2,312,767 (FY 90); total HRSA dollars is
$356,162 for the AZT program and the home based care grant.
CDC FUNDPHQ
Over the past five years Arizona has received over $4.3 million
dollars from CDC. The distribution of these funds over the past
five years is summarized in Appendix 4. For the purpose of review
funds are broken down by county and include all funding within the
county, including funding to community based organizations. Data
summarized in Appendix 4 (Distribution of CDC AIDS Funding in the
State of Arizona, 1985-1990) demonstrates:
Department of Health Service (FY 1990) relies upon
$905,648 for 15 staff positions including salaries,
benefits, travel, and other operating expenses,
laboratory services, and administration. This is 39
percent of the 1990 CDC funding.
Funding to rural counties began in 1987 and has increased
each year. DHS stated that funding amounts to rural
counties is based on negotiated work contracts to fund
a position by staff hours. Funding to rural counties is
from funds available under counseling and testing.
During 1990 there was a decline in funding to community
based agencies and the local health department in
Maricopa County.
During 1990, DHS total funding from CDC decreased by
$21,713.
Current contractual funds from DHS utilizing CDC funds during FY
1990 is documented in Table 2, pp. 32-33:
DEPARTMENT OF HEALTH SERVICES
AIDS PREVENTION AND SURVEILLANCE FEDERAL FUNDING
1/1/90 - 12/31/90
**COUNSELING AND TESTING
*CODAMA
Cochise County
Coconino County
La Paz County
Maricopa County
Pima County
Pinal County
Santa Cruz County
*Terros
Yavapai County
Yuma County
SUB TOTAL
SEROPREVALENCE
Colorado State Lab
Maricopa County
SUB TOTAL
SURVEILLANCE
Maricopa County
SUB TOTAL
HEALTH EDUCATION
Coconino County
*CODAMA
Maricopa County
Maricopa County Info. and Referral
Pima County
Pima County Info. and Referral
Tucson AIDS Project
Unobligated
AMOUNT
SUB TOTAL
AMOUNT
Central Navajo AIDS
1ndian community Health
Pascua Yacqui
Southminster Social Service
SUB TOTAL
TOTAL CONTRACTUAL
TOTAL AWARD
TABLE 2
* CDC funds are contracted to minority community based
organizations and programs to reach IV drug users. Actual
funding to community based organizations totaled $191,273 (or
13 percent of total contracted funds).
** 93 percent of all counseling and testing money is directed to
county health departments.
Table 3 summarizes the CDC funding utilized within DHS including
administrative costs:
SUMMARY OF 1990 AIDS PREVENTION AND SURVEILLANCE
PROJECT FUNDING
PERSONNEL $ 386,547
Disease Prevention $ 331,895
State Laboratory 54,652
FRINGE BENEFITS $ 96,486
Disease Prevention $ 82,422
State Laboratory 14,064
TRAVEL $ 25,300
OTHER OPERATING COSTS $ 145,449
ADMINISTRATIVE COSTS (INDIRECT CHARGES) $ 239,213
Disease Prevention $ 210,654
State Laboratory 28,559
TOTAL
TABLE 3
Future federal funding through the Ryan White Act has a 5 percent
administrative cap. Current essential indirect costs for DHS
represent 10 percent of the appropriated funds. DHS will need to
examine the area of indirect costs in light of the Ryan White Act
in order to adjust for this funding format.
ADDITIONAL FEDERAL SOURCES OF FUNDING TO ARIZONA
Currently DHS receives funding from HRSA for the AZT program and
a separate amount for home and community based care. During 1990
HRSA awarded $126,000 for home and community based care to Arizona.
These funds will be utilized to address provision of services to
those who lack other payors for these services. The AZT program
has been in place for several years and provides AZT to those who
lack health care coverage to pay for this treatment. The total
funds received for these two combined programs from HRSA is
$356,162. In the future these funds may become a part of the Ryan
White funding mechanism.
MINORITY PROG FUNDING
State and federal funding to the Black and Hispanic communities
though ADHS , have been inadequate. The Task Force and the
Oversight Committee for two years has heard from these communities
regarding the lack of support. Fiscal allocations in the minority
section of this report reinforce this allegation. The review of
funding trends indicates that funds are not reaching communities
that are having a significant rise in the incidence of HIV. There
is no long range plan for programmatic intervention in minority
communities. There is no systematic needs assessment or strategic
planning to determine how best to use funds to build programs.
Instead the state relies on a funding process based on request for
proposals that is based on the procurement code.
Communities which are experiencing the greatest need may be least
likely to be able to respond effectively to this procedure. DHS
has the capacity and authority to provide technical assistance.
Such assistance should be aggressively given. Other states provide
technical assistance through their health department including,
identifying community needs, outreach to those communities
assisting in grant writing and evaluating the adequacy of
proposals. These technical assistants are insulated from the
decision making process on the proposals and allocation of funds.
There are simply not enough funds to go around. Funding does come
from a variety of sources, including CDC, HRSA, and others. ADHS
and minority groups should be working together to maximize these
resources.
The issue of funding for programs to target the Minority community
is addressed both here and in the Minority section. This issue is
extremely important to HIV prevention. The Oversight Committee
believes that past decisions on funding specific to the minority
community, although based on the RFP process, have not addressed
the development of programs to reach those at highest risk for HIV.
Later in this report the Committee addresses other gaps including
funding and programs for gay/bisexual men, women at risk, and IV
drug users. Changes recommended include increasing technical
assistance, development of a review and resubmit procedure, and
reexamination of the RFP process.
COMPREHENSIVE PLANNING
The Oversight Committee worked closely with DHS staff to review
funding patterns and history. During this review several issues
become apparent. Arizona HIV efforts have been driven by funding
sources. Instead of a proactive planning process, programs have
been developed to respond to the funding mechanism. This
frequently results in fragmented program development.
This problem has been compounded by the limited availability of
state funds through legislative appropriation process. Funding
available from the Arizona State legislature does not expand
current programs within the communities, nor does it allow for
development of programs in areas that are under funded by federal
sources. In reviewing our sister states experiences, state funding
is critical to not only the development of prevention and direct
care resources but also the continuance of demonstration projects
as federal funds diminish.
The future impact of the Ryan White Act on the State of Arizona
will need to be monitored closely. This legislation directs
funding through the Executive Branch of Arizona government, to DHS
and DOE, requires caps on administrative costs and requires the
state to have specific policies in place for receipt of funding.
Arizona may need state dollars to meet the current administrative
costs. This Act recommends procedures for public input or planning
prior to fund utilization. The Oversight Committee has reviewed
this Acts and is pleased to note that policy requirements of the
Ryan White Act have been addressed in the AIDS Omnibus Bill (HB
2173). his placed Arizona in a policy position to apply for these
funds .
In reviewing the disbursement pattern of current funds to local
health departments and community based organizations several issues
were identified. Funding to the two largest counties, Maricopa and
Pima, appears to be directed toward positions and not performance
standards. The difference in funding between these counties
appears to not be based on work required, i.e., number of HIV
tests, number of surveillance reports, etc. FY 1990 funds to
Maricopa County, excluding funding for the Family of Surveys for
CDC, exceed Pima County by approximately 25 percent. DHS
surveillance reports indicate that 74 percent of all AIDS cases,
and 69 percent of all asymptomatic HIV cases are reported in
Maricopa County. The decline in funding to the health department
and community programs within ~aricopa County seems short sighted
in light of epidemiologic trends.
Funding from DHS to rural counties has increased over the past two
years. Services within rural counties are expensive when compared
to either the number of AIDS cases or the number of HIV tests
performed . Rural counties express concern over issues of
networking, provider knowledge of HIV, and sewice for persons with
HIV disease. Current DHS funding is for counseling and testing
and not direct services for HIV infected persons. In major urban
counties those services are provided through community based
organizations who seek a broad base of funding. Arizona needs to
examine the funding to rural areas that will maximize the dollars
spent in light of services obtained. Rural partnerships and
linkages with community based organizations in urban areas many
prove beneficial to developing services for persons living with HIV
disease.
1. Arizona should begin to implement a program allowing state
agencies to subsidize private insurance premiums. At the same
time the state should also consider setting up a health
insurance risk pool as another reasonably priced alternative
to expensive state funded health care.
2. Arizona should use the opportunity, in light of the new
federal funding mechanism, to evaluate how AIDS dollars are
currently spent and how new dollars will be utilized. Ryan
White legislation requires long range planning and specifies
the type of funding, including caps on administrative costs.
Also recommended is an HIV Planning Council in the Governor's
Office, that is comprised of community members familiar with
the service needs. This Council will assist the state in
making effective long range plans.
3. Expanded availability of anonymous HIV antibody testing, as
well as other programs and services, in non-governmental
sites. Department of Health Services should direct increased
funding to community based organizations for both preventive
and therapeutic services.
4. Appropriate federal funds be utilized during the current
funding cycles. DHS will need to implement guidelines to
assure appropriate expenditure of funds due to restrictions
on carryover funding under the Ryan White legislation.
5. DHS, AHCCCS, and community organizations should begin to
address planning for utilization of funding for community and
home based care contained in the 1991 Ryan White legislation.
Such planning will be in the purview of the proposed HIV
Planning Council once established.
6 . Funding to local county health departments should be based on
a planning and evaluation system that considers geographic
region, population, special needs within the county, and HIV
impact within the county.
7 . The HIV Planning Council should examine and pursue other
resources, including city, county, state and philanthropic
dollars, in light of the heavy past and present reliance on
federal funding for HIV/AIDS programs within Arizona.
8. DHS develop an aggressive Technical Assistance program to
assist community groups in procuring grant money.
9. DHS should revise the review process for RFP1s to ensure that
reviewers consider current funding levels, evaluation of past
performance, and incidence of HIV disease in the affected
communities.
10. DHS should make use of a revise and resubmit option for RFP1s
that potentially could impact on HIV interventions.
V. SUMMARY OF PROGRESS REPORTS
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS)
STATUS REPORT
SEPTEMBER 1990
AHCCCS currently provides treatment and all medically necessary
care for enrolled persons with AIDS, ARC, and HIV infection.
Future programs include consideration of expansion of indications
for AZT.
Current resources and funding include: Title XIX, U.S. Social
Security Act, and State appropriations. Future resource needs
include cost increases to expand drug treatment option, and
possible cost increases to expand provider network.
Plans for Inter-Agency Coordination include: consideration of
federal grants for expanded Home and Community Based Services with
the Arizona Department of Health Services, and cooperation with
community agencies.
The Task Force Report contains a number of policy initiatives
pertaining to AHCCCS. Several are reflections of program
initiatives and policies already being addressed by AHCCCS
administration or actually implemented. Others represent
significant changes in program, budget or policy and need more
detailed analysis than can be provided in this brief comment
period. The issues of concern to AHCCCS are listed below, and
accompanied by a short assessment of the impact of the
recommendation and the AHCCCS Administration's current sense of
direction.
EDUCATION MEASURES
ISSUE: EDUCATION FOR 8TATE AGENCY 8TAFF
Case managers and some long term care eligibility staff would need
training. The in-house expertise exists to conduct the training,
so costs would be limited to staff time and materials.
Work-plans have been developed to:
1) Identify employees with direct client contact.
2) Include AIDS education material in orientation packets.
3) Include AIDS education materials in Administration newsletter
twice a year.
ISSUE: CASE MANAGEMENT
Case management is currently provided to most AIDS patients
enrolled with AHCCCS plans. AHCCCS is increasing the emphasis on
case management, and will require documentation that it is being
provided. There are no special requirements for persons who are
HIV positive. It is important for AHCCCS to actively participate
in any group seeking to standardize case management in Arizona.
The budgetary and administrative consequences of some of the
proposal that have come forth are significant. In particular,
efforts by case management agencies to become "sole source
providersff fit poorly with the competitive capitated model of
AHCCCS, and can distort pricing of these services. Standards that
result in excessive services promote dependency and raise costs.
Successful case management has many of the attributes of advocacy,
and increases the intensity of medical services.
Case management has direct and indirect cost implications for
AHCCCS, and presents a coordination problem for participating
prepaid health plans. Any proposal for a statewide case management
program needs careful evaluation.
An AIDS quality assurance program is to be implemented into
contracts beginning October 1, 1990.
ISSUE: HIV/AIDS AND CHEMICAL ADDICTION
Increases in Drug Abuse treatment services are not currently
provided by AHCCCS. There are substantial costs and administrative
effects related to this recommendation.
ISSUE: MENTAL HEALTH
These services are not currently provided by AHCCCS. There are
substantial cost and administrative effects related to this
recommendation.
Currently mental health services for adults are very limited.
Phase-in of services for children is the first priority. Attention
to the needs of AIDS-affected children will be included in the
development of new services.
ISSUE: LONG TERM CARE
AHCCCS Administration has been working on smoothing the transition
from acute care to long term care programs, including improved
information exchange, a better physician network for AIDS care and
expansion of home and community based services. Changes in the 5%
cap on home and community based services have been actively sought,
without success. The use of family attendants as personal care
providers in home and community based services is not actively
being sought, and needs to be examined for its impact on other
issues, such as long term care for Alzheimer's patients and the
increase in applications it might stimulate.
ISSUE: AHCCCB ELIGIBILITY
Expanded eligibility criteria for people with AIDS is a major
policy issue, and affects primarily the state-funded portion of
AHCCCS (MN/MI). AHCCCS is currently examining the potential for
such changes. Among the questions for research are what groups
will be affected, the impact on the size and costs of the AHCCCS
population, whether only AIDS patients should be included or
whether other chronically ill patients should also be included, and
whether HIV infection or AIDS is the desirable screen. State
legislative action would almost certainly be required, along with
waivers from the HCFA.
AHCCCS is awaiting the establishment of a Governor's Task Force on
Long Term Care to study the needs and services for the chronically
ill and physically disabled population.
Work with health plans and program contractors to smooth the
transition between acute and long term care programs is ongoing.
AHCCCS provides nursing home and Home and Community-Based Services
(HCBS). Discussions are ongoing with HCFA on expanding HCBS.
ISSUE: FELLOWSHIP PROGRAM
The availability of well-trained primary care physicians to care
for AIDS patients is of considerable concern to AHCCCS, since
AHCCCS expect to have responsibility for the care of more than half
of all AIDS patients at some time in the course of their illness.
Several physicians who have been caring for a large number of AIDS
patients have full practices at this time. The lead agency for
developing the fellowship program is suggested to be the University
of Arizona medical school, which is appropriate. However, AHCCCS
expects to be actively involved.
Success in attracting primary care physicians to develop the skills
to care for AHCCCS patients with HIV disease may require some
incentives, including the possibility of differential fees or
capitation rates for trained physicians. In addition, policies on
managing the care of AIDS patients, such as channeling them to
trained physicians, may require both policy and contract changes.
No action at present in a joint effort to better train a network
of primary care physicians to care for increasing numbers of HIV
positive persons.
ISSUE: ADVANCES IN TREATMENT
New advances in treatment of HIV/AIDS should be made available
through the University of Arizona. The rules governing AHCCCS
specifically exclude coverage of experimental treatment. To date,
AHCCCS has limited coverage to FDA approved drugs, and has not paid
for experimental drugs and the related costs of participation in
experimental protocols. Changes in this position will have budget
consequences, since discrimination by diagnosis is not allowed.
The increased emphasis on experimental therapies can force changes
in the AHCCCS rule.
FlUANClNG MEASURES
ISSUE: INSURANCE
AHCCCS is interested in insurance risk pooling, mandated insurance
expansions and similar proposals.
ISSUE: COST DATA
AHCCCS would be a primary participant in cost data collection.
Proposals for this data collection will have cost and systems
implications for AHCCCS administration.
ARIZONA DEPARTMENT OF CORRECTIONS (DOC)
STATUS REPORT
SEPTEMBER, 1990
The mission of the Arizona Department of Corrections is to serve
and protect the people of Arizona by imprisoning those offenders
legally committed to the Department. This includes maintaining a
healthy, safe and secure environment for both staff and inmates.
The issue of AIDS continues to be a major concern for the
Department. Policies are in place that address testing, housing,
treatment and confidentiality. DOC has solicited assistance from
other agencies, specifically the Department of Health Services, in
the development of its policies and programs.
All that has been accomplished in DOC in reference to AIDS has been
done without additional resources. Given the current fiscal
situation of the agency, it will be difficult to implement any new
programs without additional resources. DOC encourages the Task
Force to pursue its objectives through the Governor and the
Legislature.
SPECIAL NEEDS
ISSUE: MANDATORY HIV ANTIBODY TESTING FOR NEWLY ADMITTED INMATES
A blinded Seroprevalence survey for HIV antibody testing and
Hepatitis B surface antibody (anti-HBs) was conducted in early 1990
on new male inmates entering the Department of Corrections. Data
was gathered from 1058 volunteers which examined limited risk
behavior information and was correlated with seroprevalence
results. Overall results indicated a 1.5 percent HIV antibody
seroprevalence and 22.5 percent anti-HBs seroprevalence. None of
the behavior risk factors including male to male sexual contact,
needle sharing, or history of blood transfusion were reliable
surrogate workers for HIV infection. Approximately 75 percent of
all inmates volunteering for this study indicated they would
volunteer for anonymous and/or confidential testing.
ISSUE: EDUCATIONAL PROGRAMS FOR INMATES AND STAFF IN CORRECTIONAL
FACILITIES
The Human Resources/development Division of DOC is proposing that
two of the Task Force's recommendations be pursued this year.
Priority #1:
AIDS Training for Staff and Inmates. DOC recommends that a broader
approach be taken that provides training, data collection, and
treatment protocols for communicable diseases, not just AIDS, and
that security staff be immunized against Hepatitis B, mumps,
measles, and Rubella (MMR). The cost is $427,400.
In an effort to address these major issues, DOC is issuing a
Request For Proposal for professional services. This request
includes educational programs for staff and inmates; clinical care
of inmates identified as HIV+, ARC, and AIDS; gathering of
statistical data; and, establishing treatment guidelines which
include post-release continuity of care utilizing community
resources.
ISSUE: HIV/AIDS MEDICAL CARE AND TREATMENT IN THE CORRECTIONAL
GETTING
Priority #2:
HIV/AIDS medication. Over the next three years, it is anticipated
that the detected number of HIV positive and AIDS infected inmates
will increase from 39 to 300. DOC concurs with the Task Force
recommendations that AZT treatment be provided to all known
infected inmates. The cost pattern is as follows:
ANNUAL INCREASE CUMULATIVE INCREASE
FY 1991 (1st Year) $146,600 $146,600
FY 1992 (2nd Year) $241,700 $388,300
FY 1993 (3rd Year) $241,700 $630,000
DOC is continuing to provide necessary medical care and counseling
to those inmates identified as HIV positive, ARC or AIDS. The
treatment protocol for AZT has been updated to reflect changes
recommended by the Center for Disease Control (CDC).
DOC is continuing its efforts to address the issue of AIDS in the
prison setting. Through an outside contractor, the issues of needs
assessment, short and long term health programs, inmate and staff
education, prevention and post release follow-up will be studied.
This information, along with the results of the blinded
seroprevalence study will assist in the Department's formulation
of revised policies and procedures. Policy and Procedure is being
developed to address the issues of consent to test and treat,
confidentiality and disclosure of information. This is to ensure
compliance with the recently enacted ARS 36-663, 664,667.
ISSUE: PREVENTIVE ISSUE8 IN CORRECTIONAL FACILITIES
DOC is not considering the issuing of condoms in the prison
setting. The supplying of condoms remains a security issue and
could be viewed as condoning acts that are in violation of DOC
rules and regulations, and law. The Department has followed the
recognized premise that the best prevention is good education.
STATUS REPORT
SEPTEMBER 1990
The passage of HB 2173 together with the provisions of ARS 920-448
provide statutory authority to the Insurance Department to
promulgate its previous guidelines as rules. The Department of
Insurance is in the process of drafting rules to implement
allowable tests and testing procedures, written consent to perform
HIV related test procedures for confidentiality and disclosure of
medical information, procedures for gathering underwriting
information, and other rules that are reasonable and necessary to
implement A.R.S. 920-448.01 as enacted by HB 2173. These rules
will consist of the Department's current "AIDS Guidelines.@'
Because the rule-making procedure is quite lengthy the adoption of
rules will not occur prior to September 27th, effective date of HB
2173. Therefore the department has prepared a model consent form
for HIV testing. Until adoption of the rules, insurers may choose
to use the model consent form or may submit the forms they
currently use for approval by the Department of Insurance. The
following areas summarize the Department's response to critical
areas outlined by the Task Force.
Areas Where Inquiry Would be Prohibited and Sexual orientation:
The Department has adopted l1AIDS Guidelinesl1 which prohibit
insurers from inquiring into the applicant's sexual orientation,
the applicant's receipt of blood transfusions or applicant's
previous HIV tests, except that the insurer may ask whether the
applicant has ever been diagnosed or treated for HIV disease, or
has tested positive for HIV antibody.
Uniform Application of HIV Tests; Uniform Testing Based on Type,
mount of Policy, and Testing in Conjunction with other Medical
Procedures: Guidelines permit an insurer to test for HIV
antibodies as it tests for other conditions affecting mortality and
morbidity. Tests cannot be performed without written consent of
the applicant.
Informed, Written Consent and Prescribed Testing Protocol: AIDS
Guidelines prohibit the use of test results as a basis for an
adverse underwriting decision unless the insurer has verified that
both a positive screening test (such as ELISA) and a positive
supplemental test (such as Western Blot) result have been
determined. Tests must be FDA-approved. A standard consent form
has been drafted by the Department.
Periodic Review of State Testing Technology to Revise Protocol:
Department of Insurance will promulgate regulation and will
coordinate with Department of Health Services to gather necessary
information and advise regarding appropriate test protocols.
Counseling (Pre-and Post-Test):
Rules will require discrimination of information regarding the
availability of free confidential counseling along with a time
frame for the person to seek such counseling.
Confidentiality:
House Bill 2173 authorizes Department of Insurance's rule-making
authority regarding confidentiality of HIV testing.
Exclusion of Certain Types of Conditions: Guidelines do not permit
insurers to issue for delivery in Arizona any contract which
excludes AIDS or ARC from coverage. Benefits for AIDS and ARC
shall be provided for in the same manner as are provided for all
other catastrophic disease.
Classification of Treatments: Policies which include benefits for
prescription drugs shall provide benefits for AZT as well as any
and all other FDA approved drugs and forms of treatment.
Risk Pooling: Department of Insurance is examining other states'
risk pools in conjunction with the Joint Legislative Committee on
Health Care.
Change in ERISA: Department of Insurance has been and continues
to work in conjunction with the National Association of Insurance
Commissioners (NAIC) to inform Congress of changes we believe are
required.
Reimbursement of Drug Treatment: Guidelines require that where
policies provide benefits for treatment and drugs, benefits must
include AZT as well as any other drug approved by the FDA.
ARIZONA DEPARTMENT OF ECONOMIC SECURITY (DES)
STAWS REPORT
SEPTEMBER, 1990
The DES provides opportunities, services and programs through an
integrated delivery system to Arizonans with economic or social
difficulties which will enable them to maintain or move toward
self-sufficiency. The recommendations of the Task Force are very
broad and will require the cooperation of many agencies within
state government. DES is supportive of a cooperative effort to
lessen the threat of this epidemic in Arizona. The recommendations
which are implemented have been accomplished within current DES
resources. Funding includes Children's Services, Day Care and
training dollars. The number of children with HIV currently cared
for by the department is minimal. As the number of children in
care increases, special budgetary needs will become a factor.
Immediate funding is necessary to carry out department wide AIDS
training. The Task Force clarified and brought to immediate
attention AIDS issues that needed to be addressed by DES.
ISSUES: CHILDREN UFECTED BY HIVIAIDS
Testing children for HIV: The recommendation is implemented.
The current Administration for Children, Youth and Families (ACYP)
AIDS Policy supports careful testing of foster children with
cautious interpretation of test results, Guidelines for case by
case assessment of testing needs are found in the Testing, section
H. of the ACYF AIDS policy. The issue of confidentiality, and
disclosure of information on a need to know basis is also a part
of the current AIDS policy.
Recruitment and AIDS education of foster families: The
recommendation is implemented. At this time recruitment of foster
families for HIV/AIDS affected children is done on an as needed
basis because the need has not demanded an aggressive campaign.
ACYF has a copy of the Child Welfare League of America (CWLA)
recruitment video which focuses on families to care for this
population. This can be shared statewide when needed. In
addition, the ACYF Statewide Recruitment and Retention Task Force
can be utilized to organize aggressive recruitment strategies when
needed. Recruitment and licensing for this population requires
involvement of local medical resources to adequately train
potential care-givers. Both the Phoenix and Tucson areas are
already using some of these resources for the limited number of
children in the department's care.
Foster care incentives: The recommendation is implemented.
The ACYF AIDS Policy allows for incentives for foster parents to
care for children infected with HIV. At this time reimbursement
for care is done on a contracted basis allowing for the individual
needs of a particular child. The foster care rate schedule is
utilized as the basis in developing the contractual agreement.
Relative caretakers can be licensed foster parents and receive the
same benefits.
Free or subsidized day care: The recommendation is implemented.
Day care services include care provided in licensed day care
centers and certified day care homes on a regular basis for
compensation and lasting for periods of less than 24 hours a day.
Day care subsidy is available to eligible clients with HIV infected
children. Clients are advised of available homes and center
placement options. Any facility knowingly accepting an HIV
infected child shall be fully trained in the care and supervision
of such children and adequately staffed to handle these needs.
Appropriate transitional facilities: The implementation will be
considered if the need arises. Because of the minimal numbers of
HIV/AIDS affected children in the department's care in Arizona at
this time, there has not been a need for such a service. ACYF is
not entirely supportive of group care programs forthis population.
As this need arises, the department would prefer contracting for
a service which could be delivered in the child's family home or
foster home. A request for Proposals (RFP) could be developed in
preparation for in-home services which may also benefit the drug
affected/addicted baby population.
EDUCATION MEASURES
ISSUES: EDUCATION FOR STATE AGENCY GTAFF
Staff education for day care centers: The recommendation is being
implemented. DES will give specialized training to DES and
contract agency staff, licensed foster families, certified adoptive
families and day care providers who provide direct physical care
to children and adolescents with known HIV infection. Respite
services are available through the assigned case manager. In-depth
training has been implemented for ACYF and DDD staff. Department-wide
training will be implemented in FY 1991.
The DES Office of Human Resources (OHR) will coordinate AIDS
training for the department. It will:
* Identify qualified community professional or health services
organizations which are willing to provide training for DES
on a volunteer basis.
* Develop the training schedule, promote the training, enroll
participants, and assemble resources;
* Evaluate the training content and presentation to ensure
highest quality.
ISSUE: EDUCATION FOR HEALTH CARE INSTITUTIONS
HIVIAIDS Education in Health Care Institutions: The recommendation
is implemented. The Division of Developmental Disabilities (DDD)
has developed and implemented a training module on HIV/AIDS for the
Intermediate Care Facility/Mentally Retarded staff which is
included in the required basic training.
SUPPORT AND TREATMENT MEASURES
ISSUES: CASE GEMENT
DES would appreciate the opportunity to provide a representative
in the development of a Task Force as recommended to address the
issues that relate to case management and client services. There
is no additional cost associated with this recommendation at this
time .
ISSUE: LONG TERM CARE
Long-Term care options: The recommendation is implemented.
All recommendations concerning both the short and long-term care
of an HIV infected child accepted by the DES system are made by the
child's appointed service team including the physician, DES case
management, unit supervisor, child's guardian ad litem/CASA,
potential providers/caretakers and/or adoptive parents. This
service team continually monitors the placement of the child and
adjusts according to the child's condition. Medical care is
provided through the DES comprehensive Medical and Dental Program
(CMDP) .
ARIZONA DEPARTMENT OF EDUCATION (DOE)
STATUS FIEPORT
SEPTEMBER, 1990
Objectives for the 1990-1991 Budget Period:
1) The budget will remain the same as last year $215,616.
Department of Education has additional carry over funds which
will make it possible for the Department to set up two
regional training centers to better assist rural communities
in their HIV Education and prevention efforts.
2) The Centers for Disease Control specifies that the Department
demonstrate increases in:
* the number of junior and senior high school students who
receive HIV education; and
* the number of junior and senior high school students who
receive HIV education within a Comprehensive Health
Education Program.
To demonstrate these increases we are required to conduct two
annual surveys :
* The HIV Educational and Policy Development Survey which
is sent to over 1000 schools throughout the state, and
rk The Youth Risk Behavior Survey (YRBS) which is to be sent
to approximately 50 schools, involving 2500 students at
grades 9-12. This survey asks questions about individual
involvement in several high risk behaviors including drug
use, sexual activity and suicidal thoughts or attempts.
Both surveys are voluntary and will be encouraging full
participation. 1990 will be the first attempt with the YRBS but
it has been approved by the DOE Program Review Committee and has
been endorsed by the National PTA, National School Board
Association and National State Boards of Education. Department of
Education is hoping such support will further encourage school
districts to participate.
To accomplish the above objectives a number of activities have been
planned including a continuation of one and two day regional
training programs at no cost to the school districts; regional
updates for educators and administrators who have already attended
a two day intensive; regional parent education programs, and
programs specifically designed for local school boards and school
administrators.
The Governor's Task Force On AIDS recommendations are in complete
agreement with the stated objectives of DOE. In light of
diminishing resources specifically for HIV education in schools,
the Department is exploring the potential of including HIV
information and prevention strategies into several of the Substance
Abuse Prevention Programs currently operating in many of the school
districts. Student Leadership and Peer Education models have also
begun to bear fruit. The Flagstaff Unified School District for
instance has recently received a $7000.00 award from the
Metropolitan Life Insurance Company for their "Healthy Mett Program
including $2000.00 for the HIV Education Component. Several
Arizona schools have received national recognition from the United
States Department of Education (USDOE) for the their excellent
substance abuse prevention programs. Most of these programs
already include skill-building in areas such as refusal skills,
coping with peer pressure and self-esteem enhancement projects.
The USDOE also requires an annual drug use survey in conjunction
with Drug Free schools funding which is conducted at both the
elementary and secondary level by the Arizona Criminal Justice
Commission.
EDUCATION MEASURES
ISSUE: SCHOOL-BASED EDUCATION
By the beginning of the 1989 budget period, a HIV Education
specialist had been employed at the Arizona Department of Education
for six months. After reviewing the results of the first AIDS/HIV
Education and Policy Development Survey, which included a brief
needs assessment, (see attached 1989 report), it was determined
that the first priority would be to conduct eleven, two-day
regional training programs which would include information on
policy development, age specific curriculum suggestions, an
extensive 'IAIDS 101" program and, whenever possible, presentations
by persons living with HIV disease. It should be noted that 77%
of all districts responded to the survey, despite the fact that
HIV Education is not mandated. This response far exceeded
projections.
The goal of the training program was three-fold:
* to reduce the fears surrounding HIV infection and increase the
comfort level among school personnel about having a child or
adult with HIV in the school setting,
* to let districts know that there was a person on staff at DOE
who was available to assist them in their HIV education and
policy development efforts and,
* to build a statewide coalition of support for the concept of
providing HIV instruction within the context of a
comprehensive school health curriculum. The evaluations of
the programs were very encouraging, and further evaluation
will be accomplished when the results of the 1990 HIV
Education and Policy Development Survey are compiled. DOE has
hired a consultant to analyze the survey data and prepare a
full data report; The DOE Education Specialist has reached
approximately 40% of Arizona school districts with free, HIV
educational programs. While not every district has named an
HIV Education Coordinator, the person often identified is a
school nurse. Several individuals working in the HIV
education field are now assisting schools in their perspective
counties both as volunteers and paid consultants. Seven
excellent HIV educators report they have assisted over 300
schools reaching approximately 13,000 students and 880 school
personnel. These individuals have attended one of DOE'S two
day regional workshops and additional training from DHS.
These individuals and DOE staff meet on an ongoing basis to
provide mutual support, share ideas and problem solve.
Since there has not been an opportunity to analyze DOE survey data,
it cannot be determined whether there has been an increase in the
number of Junior and/or Senior high schools, which offer HIV
education. Department of Education is certainly anticipating a
small increase. The familiar problem is that health instruction
is not required beyond the eighth grade in Arizona, so teachers do
not have a context in which to teach the subject. DOE is
attempting to rectify this situation in five ways:
1) DOE has supported H.B. 2361, which would require instruction
on Acquired Immune-deficiency Syndrome (AIDS) and the Human
Immune-deficiency Virus (HIV) in grades K-12.
2) The Comprehensive Health Essential Skills for grades K-12 have
been approved by the Arizona State Board of Education. The
approval by the Board does not mandate comprehensive health
in either kindergarten or grades 9-12, however it does lay a
foundation for an intensive training effort to encourage
participation, especially, in the upper grades.
3) Training programs offered during the Fall 1990 and Spring 1991
school year will have either an elementary or a secondary
focus, thus allowing more time for age specific instruction
and practice. Training capacity will be expanded with the
use of regional training consultants and will include more
information on minority issues, which hopefully will attract
more high school teachers and/or administrators in our inner
city schools.
4) DOE arranged to play a greater role in school team training
this year. School teams from throughout the state come
together for four days and nights to develop substance abuse
prevention plans for their school or district. This year DOE
will be encouraging teams to incorporate HIV information and
prevention strategies into their plans. Since many of these
schools do not have comprehensive health education, chemical
abuse prevention programs are a logical resource.
5) The Comprehensive Health Unit's HIV Program sends a
newsletter, every other month, to all public school district
superintendents, BIA school administrators, all school nurse
supervisors (over 200 statewide), all former participants in
regional training programs and all county health departments
and community service agencies serving youth at risk. The
newsletter serves as a resource regarding upcoming events,
news briefs, accolades for model HIV education programs, and
in Fall, by request, a Question & Answer column. By providing
support to schools who have not yet participated in trainings,
DOE is hoping to motivate them to participate in the next
series of workshops.
ISSUE: EDUCATION FOR STATE AGENCY STAFF
The Task Force also addressed the issue of HIV Education for DOE
staff. An educational program on HIV was presented to management
in June of 1989 and three consecutive employee programs were
provided during the month of July 1989. The HIV Education
Specialist conducted the program with the assistance DHS staff.
The response was very positive. The HIV Specialists are planning
an employees Update during the 1990-91 grant period.
SPECIAL NEEDS
ISSUE: YOUTH AND HIV/AIDS
On April 19-20, 1990, the Department sponsored a conference
entitled, l1What Works! HIV 1nt.ervention Strategies For Out-of-
School Youthv1. Twelve agencies assisted in the planning and
implementation of the event, which drew over 125 people each day,
including presenters. Sixty-four agencies were represented, which
is 32% of the 200 youth serving agencies registered in Arizona.
This was a good beginning and a meeting has been scheduled to
evaluate our efforts and begin planning for our 1990-91 conference.
The CDC has also made it possible for the Department to take school
personnel, staff from agencies serving out-of-school youth and
county health departments personnel to regional training centers
for a 3-5 day intensive HIV education program. Representatives
from Tucson Unified School District, Phoenix Union High School
District, Urban League, Matrix Incorporated, Our Town Family
Centers, Tumbleweed, Glendale Youth Centers, Arizona Department of
Corrections and the Maricopa County Homeless Outreach Program have
attended such programs.
To achieve the objective pertaining to HIV education for
developmentally-delayed students, the Department invited a
consultant who had experience with HIV education to this population
to present a half-day workshop at the DOE annual Special Education
Conference on March 2, 1990. Unfortunately, attendance was light
(25 people) for this concurrent session, so a committee on HIV
education for special populations has been formed to develop
strategies for reaching a larger Education Programs. The new HIV
education specialist has certification in Special Education and is
very interested in chairing this new committee.
The Youth Risk Behavior Survey was not completed this year. The
HIV Education Specialist hired to take the lead on this project
resigned due to health related problems. Unfortunately, it took
several months to hire a replacement and the remaining HIV
specialist was already committed to numerous training projects.
Upon evaluation it was determined conducting a student survey late
in the year would be detrimental to the relationship between DOE
and local school districts. The Drug Use Survey in Arizona
Schools, conducted by the Arizona Criminal Justice Commission in
cooperation with the DOE and USDOE, (United States Department of
Education), has also recently been conducted in the schools.
Fourteen of the questions in this survey are also included in the
Youth Risk Behavior Survey.
The Centers for Disease Control also requires that the Department
assist agencies serving youth who are not attending traditional
school programs. The Department plans to conduct an annual
conference specifically designed to assist agencies serving youth
at special risk for HIV infection and will also keep these agencies
updated with information through the departments HIV newsletter.
A committee of representatives from CBO1s serving youth at risk
will be assisting the Department in planning efforts.
STATUS REPORT
SEPTEMBER, 1990
The Arizona Department of Health Services involvement in the public
health challenge posed by AIDS began in 1982 when the Centers for
Disease Control (CDC) requested that all states determine
retrospectively if AIDS cases had occurred and at that time DHS
established prospective AIDS surveillance systems.
Since that time, DHS AIDS program, located within the Division of
Disease Prevention, has grown from a zero budget and no positions
to annual funding of over $3.0 million (approximately $450,000
state, $2.7 million federal) and 22 staff (5 state funded, 17
federally funded). Of the funding received, approximately $1.6
million directly supports local health departments and community
organizations in their efforts against HIV infection and AIDS. In
addition, more than $200,000 is currently being utilized to
purchase Zidovudine for distribution through DHSws AIDS therapy
distribution program.
In July, 1990 the DHS AIDS Education staff merged with the HIV
Program Section staff to create the Office of HIV/AIDS Services.
Previously, the AIDS Health Education staff was part of the Office
of the Office of Health Promotion and Education, and the HIV
Program Section staff was part of the Office of Infectious Disease
Service. Because the staffing, funding and programming mix of DHS
HIV/AIDS activities have grown so significantly over the last four
years, it was determined that an office on AIDS should Itstand
alonew1 rather than as part of two separate offices. Additionally,
HIV/AIDS issues represent a significant public health priority in
Arizona, warranting a coordinated focal point, visibility and
accountability. The HIV/AIDS Epidemiology Section, is responsible
for AIDS case reports, Family of Surveys and other specialized
epidemiologic studies. Because this is primarily an internal
organizational change, staffing and program and activities will
remain virtually unchanged.
AIDS-related activities involve every division of the Department.
Current programs cover a broad base of areas of HIV/AIDS, including
surveillance activities, seroprevalence studies, counseling and
testing programs, minority education initiatives, public
information programs, and programs directed at intravenous drug
users and gay/bisexual men. In addition, the Department continues
to work closely with a wide variety of community agencies and with
other State agencies. Details of these programs and coordination
activities is included in the Task Force Report of November, 1989.
ISSUE: CONFIDENTIALITY OF HIV INFORMATION
HB 2173 contained agency sponsored sections that provide for
enhanced protection of communicable disease information as
recommended by the Governorls Task Force.
ISSUE: DUTY TO WARN OR PROTECT
This section of HB 2173 authorizes physicians to notify sexual and
needle-sharing partners of infected individuals and health care
workers exposed to infected individuals. DHS contracts with nine
county health departments and require that counties assure that
partner notification takes place and, as necessary or requested,
perform partner notification services.
ISSUE: TESTING AND COUNSELING
DHS does not believe that a formal certification process for
anonymous testing beyond county sites is either practical or in the
best interest of public health. A certification process would be
required and additional resources needed. Currently, DHS has
adopted a permanent rule to replace the 18-month emergency rule
A.A.C. R9-6-701 that would continue to require all county health
departments to offer an anonymous testing option. In certain
instances, under county supervision, anonymous counseling and
testing is being offered at non-county sites.
ISSUE: POST-TEST COUNSELING
DHS has requested additional funding for HIV counseling without
success from the State Legislature for the past several years. In
addition, the DHS continues to seek additional funding from CDC for
HIV counseling and testing activities.
EDUCATION MEASURES
ISSUE: HIV/AIDS EDUCATION FOR ALL ARIZONA CITIZENS
With respect to general media campaigns, the DHS serves as state
liaison for CDC national media campaign, ItAmerica Responds to AIDSt1
which is directed toward reaching all Arizona citizens. DHS
orchestrates a month-long awareness campaign during October, which
is recognized as national AIDS Awareness month. DHS publishes a
quarterly statewide newsletter on HIV/AIDS. This publication is
distributed to over 13,500 people throughout Arizona.
ISSUE: SCHOOL-BASED EDUCATION
DHS co-developed the existing guidelines for curriculum development
and continues to work cooperatively with the Department of
Education. DHS funds, through CDC monies, health educators in
several local health departments who in turn provide HIV education
programs in schools.
ISSUE: EDUCATION FOR HEALTH CARE PROFESSIONALS AND
PARAPROFESSIONALS
A clinical public health guide for physicians is being developed.
This guide will include information for physicians on HIV
counseling and testing, reporting requirements, evaluation and
treatment issues, as well as resources for referrals. DHS staff
serve on the Advisory Committee for the federally funded
professional education programs at the University of Arizona and
Maricopa County Area Health Education Center grant. In addition,
DHS works closely on a continuing basis with the Arizona Medical
Association, the Arizona Osteopathic Medical Association, and the
Arizona Hospital Association on professional education issues and
programs.
ISSUE: HIV/AIDS EDUCATION FOR STATE AGENCY STAFF
DMS is currently exploring methods of including information on
HIV/AIDS in new employee orientation. DHS has consulted with other
state agencies including the Departments of Transportation, Public
Safety and Economic Security to assist them in developing HIV/AIDS
workplace education programs. DHS has provided training in the
past for all DHS employees on a voluntary basis.
ISSUE: OUTREACH
Currently, outreach models are used in the following funded
programs: Tucson AIDS Project, for persons who are gay and IV drug
abusers, high risk adolescents and IV drug abusers; Southminister
Social Services to reach the Black and Hispanic community in South
Phoenix; CODAMA for IV drug abusers in Maricopa County; Indian
Community Health Service, Inc. to reach Native American men and
women at increased risk. Subcontractors through Maricopa and Pima
County Health Departments utilize a variety of outreach methods
including contacts at bars and events in the gay community. DHS
will be requesting additional state funds to support further
outreach activities in its upcoming budget request.
ISSUE: MINORITY ISSUES
DHS currently provides $157,000 in federal funds for AIDS education
in minority communities. In addition, DHS will be requesting
additional funds to augment current efforts. DHS is also providing
technical assistance through the use of national minority
consultants who will conduct evaluations of existing programs.
Minority contracts are written for two year periods and will
continue to be supported for two years to allow Contractors
adequate time to plan, implement and evaluate their HIV education
programs. With regard to a comprehensive epidemiologic study of
HIV/AIDS among minorities, current DHS seroprevalence studies and
surveillance data do not demonstrate the need for special study.
ISSUE: YOUTH AND HIV/AIDB
DHS intends to continue to work collaboratively with DOE and to
allocate staff time to identify potential sources of funds for high
risk youth. DHS has funded two projects who have developed peer
group leaders for the Hispanic population and high risk minority
teens. In Pima County, the Tucson AIDS Project provides regular
AIDS education sessions for incarcerated youth, A liaison has been
established with the Training Coordinator for the Arizona
Department of Corrections (DOC) and the Regional Health
Administrator at Adobe Mountain. DHS will develop additional
training programs in coordination with the DOC staff.
ISSUE: WOMEN AND HIV/AIDS
DHS has completed a statewide survey to assess the current status
of HIV education provided in public prenatal clinics and family
planning clinics. On the basis of the survey results, DHS will
develop a strategy to encourage women's clinics to provide HIV
education as part of routine services. DHS will be requesting
supplemental CDC funds to purchase brochures specifically directed
toward women. All DHS funded family planning contracts have a
provision requiring contractors to provide HIV education and
referral for counseling and testing when appropriate. The State
Laboratory provides HIV testing services for several community
based clinics that primarily serve women in several areas of
Arizona, including Planned Parenthood Clinics,
ISSUE: GAY AND BISEXUAL MEN
Focus groups to supplement the formal KAB and to provide future
direction to the prevention activities including a proposed media
campaign have been organized. Focus groups, in combination with
the formal working in the community, will provide the data needed
to direct the prevention effort in the 1990's. A community
planning committee should be organized by the gay community in
cooperation with, not by DHS. Additional funds are needed to
support the educational efforts in the gay/bisexual community
including gay/bisexual men in the minority community. DHS issued
a request for proposal for this target population, and one contract
exists with Indian Community Health Service, Inc. for high risk men
and women. In order to adequately support AIDS prevention
activities in the gay/bisexual community, the DHS is requesting
additional state funding through an upcoming budget request.
ISSUE: PREVENTIVE ISSUES IN CORRECTIONAL FACILITIES
This recommendation represents a policy decision on the part of
the DOC. DHS is willing to provide technical assistance as
necessary in developing appropriate policy.
ISSUE: DECONTAMINATION OF EMERGENCY TRANSPORT UNITS
DHS Division of Emergency Medical Services will incorporate
procedures for decontaminating vehicle non-disposable equipment
into its proposed statewide "Minimum Standards for Non-physician
Pre-hospital Treatment and Triage of Patients Requiring Emergency
Medical Services1@. In addition, the Division of Emergency Medical
Services will require certified emergency medical service providers
to maintain written policies and procedures for the decontamination
of patient transportation vehicles.
ISSUE: RURAL AREAS
An assessment of current funding levels from DHS to rural health
departments has been conducted. Listed below are 1990 aggregate
funding levels for rural and urban counties with DHS contracts for
HIV health education/risk reduction and HIV counseling and testing.
Rural counties include Cochise, Coconino, La Paz, Pinal, Santa
Cruz, Yavapai and Yuma. Urban counties include Maricopa and Pima.
Total 1990 funding ~unding per Funding per
from ADHS capita AIDS case
Rural $253,874
Urban $484,487
DHS has consistently sought additional funding both from CDC and
from the State of Arizona to augment current AIDS education funding
levels for local health departments. Annually, DHS holds a
statewide meeting of all county health department AIDS personnel
in the Spring and an HIV Health Education Conference in the Fall.
ISSUE: BIV/AIDS AND CHEMICAL ADDICTION
DHS Division of Behavioral Health Services is continuing to provide
funding for substance abuse programs through the administrative
entity system. Recent increases in federal funding specifically
for treatment of intravenous drug use has increased the number of
available treatment slots. At this time, there are no plans to
develop a special incentive program for out-of-treatment IV drug
users to seek treatment. Instead, DHS Divisions of Behavioral
Health Services and Disease Prevention will continue to work with
community agencies to strengthen outreach programs designed to
encourage persons both to seek treatment for substance abuse and
to reduce risk of HIV infection. The need for a special
feasibility study concerning needle and syringe exchange programs
is being explored. The Division of Behavioral Health Services is
currently working with the Department of Economic Security and the
Arizona Health Care Cost Containment System (AHCCCS) to implement
a comprehensive program for drug using women. The Division of
Behavioral Health Services is continuing to gather data on drug
abuse in Arizona. Comprehensive data reports will be produced at
the end of the fiscal year.
ISSUE: MENTAL HEALTH
The DHS Division of Behavioral Health Services is exploring the
necessity and practicality of developing a task force specifically
to address the issues relating to the mental health of HIV/AIDS
patients.
ISSUE: FELLOWSHIP PROGRAM
As appropriate, DHS AIDS Program staff will continue to provide
consultation in the development of this program.
ISSUE: COST DATA
The Office of AIDS will continue to cooperate with AHCCCS and the
DHS Office of Health Economics and Facilities Review in further
refining methods to determine trends in health care costs due to
HIV-related illness.
ARIZONA DEPARTMENT OF PUBLIC SAFETY (DPS)
STATUS REPORT
SEPTEMBER, 1990
As AIDS developed into a national health problem, issues
surrounding this disease became a vital topic of concern to all
members of the law enforcement community. It is well established
that law enforcement personnel, paramedics, hospital workers and
others are in daily contact with persons or biological specimens
suspected of containing the AIDS virus.
A review of the Governor's Task Force Report on AIDS reveals
several issues that will have an impact on the Department of Public
Safety and law enforcement agencies in general.
P NTlON MEASURES
ISSUE: CONFIDENTIALITY OF HIV INFORMATION
This entails several areas of concern regarding disclosure of HIV
related information, civil/criminal penalties and types of
information requested.
RIGHTS PROTECTION MEASURES
ISSUE: VICTIM'S RIGHTS
Advocacy groups have shown strong support for victims of violent
crimes in which significant exposure to bodily fluids has been
documented. These same groups support legislation giving crime
victims access to HIV related information to criminal offenders.
OTHER ISSUES OF CONCERN TO LAW ENFORCEMENT
Corrections (educational testing, treatment, prevention and inter-departmental/
law enforcement communications).
Discrimination
Transport Units and Crime/Accident Scene Decontaminations
HB. 2173 AIDS OMNIBUS BILL
The Department legal staff is reviewing this legislation which
became law on June 1990.
SUMMARY OF COUNlY HEALTH DEPARTMENTS
CURRENT STATUS
COCHISE
Provides HIV testing and counseling, community outreach, local
resource for AIDS information; develops and implements community
prevention programs; train Public Health Nurses to test and council
for HIV; is expanding programs for Hispanics and IVDUvs; is
implementing teenage/peer advocacy program in high schools; needs
community outreach workers trained in reaching IV drug users, also
need assistance in training local counselors on how to counsel
persons about HIV.
COCONINO
Provides HIV testing and counseling. Currently involved in HIV
education within the community and with health care professionals.
Have networked with the Native American community in the county to
address HIV education as well as other public health issues.
Provide HIV educational materials and seminars within the county
area. Have actively participated in coalitions and networked with
others both in the county and the state to address HIV issues.
GRAHAM COUNTY
Provides anonymous testing with pre and post-test counseling by
appointment only; distributes HIV educational literature to Family
Planning Program clients and to any client diagnosed with an STD;
counseling is given to all STD clients on a one-to-one-basis; all
HIV related efforts are funded by the County; application for a
contract with DHS will be made when the demand for this service
arises. At present the demand for more resources is low.
GREENLEE
Provides anonymous testing and counseling is offered; offers
preventive education to school and community based organizations;
identifies clients at risk by using "AIDS High Risk Questionnairett;
no money from DHS for HIV/AIDS programs; county dollars support
staff in providing services and materials.
MARICOPA
Provides risk reduction education to general community through
Speaker Bureau and programs targeted at Minority women, and gay
community. (through contracts with community based organizations).
HIV testing and counseling is available at STD clinic and Homeless
site; AIDS surveillance (case investigation, contact tracing with
consent, statistical compilation); case management through HRSA
grant (through 9/30/90) ; integrated Primary Health Care and IV drug
rehabilitation to users and their families to reduce spread of HIV.
Current funding through DHS from CDC to Marico~a County includes:
$ 95,538/year for surveillance
(80,000 state; 15,538 federal)
$ 95,00O/year for family of surveys
$105,494/year for health education
$157,00O/year for HIV counseling and testing
Federal funding from:
$ 407,70l/FY 1990 HRSA
(Health Resource Services Administration)
$ 375,00O/FY 1990 BCHDA
(Bureau of Health Care Delivery & Assistance)
County Funding:
$ 20,000 for volunteer coordination subcontracted to
Phoenix Shanti Group.
Additional funding is needed for health education/risk reduction
in gay/bisexual community, minority communities, for sexually
active adolescents, and for women at risk. Additional resources
are needed to increase ability to do contact notification and
tracing
NAVAJO
Provides pre and post test HIV counseling and anonymous partner
notification counseling with family and friends as needed.
Appropriate referrals for individuals impacted by HIV; community
education via Public Health Nurses panel and videos is provided.
PIMA
Provides HIV counseling and testing; genera1 and targeted HIV
education and preventive services and education to provided
targeted intervention with IVDUs and their sexual partners.
Developed a risk reduction project for gay/bisexual men; Conducts
media campaigns; performs disease investigation, surveillance and
confidential partner notification; networks and collaborates in
Pima County and around the state; working with and developing HIV
education programs in ethnic minority communities.
The following is a list of resources from which Pima County
receives funding. Included below are the sources of funds, the
amountstand specific areas targeted by the funds:
Source
PCHD
ADHS
Annual Amount Area/Servises
Funded
Program Administration
Advertising/Media
Campaigns.
$ 52,595 Surveillance, Case
Investigations, and
Partner Notification
Assistance.
ADHS/CDC $104,003 HIV Health Education/
Prevention/Risk
Reduction.
ADHS/CDC $117,388 HIV Counseling and
Testing Services.
NIDA
HRSA
In&ewention/Outreach/
Research with IVDU1s
and Sexual Partners.
$135,000 HIV Services Planning
Psoj ect .
PINAL
Provides anonymous or confidential pre and post test counseling and
testing, performs surveillance activities; coordinates a speakers
bureau to address community educational needs. Resources needed
include HIV knowledgeable primary care providers, increased
community education for both low risk and at risk populations,
increased resources for providers, and increased funding for both
direct care resources and prevention activities.
YAVAPAI
Provides HIV counseling and testing. Cooperated with Veterans
Administration Hospital and with Yavapai Guidance Center regarding
the coordination of HIV support groups. Need additional funding
to expand services.
YUMA
Provides HIV counseling and testing; conducts case investigation,
confidential partner notification and community education. Need
additional resources to provide programs and support for people
with HIV.
FUTURE PLANS
COCHISE
Developing local support groups to assist persons living with HIV
disease with services, support and resources; establishing a social
services committee for programs for to assist with education and
prevention programs.
COCONINO
Continue to address HIV education and prevention with high risk
populations. Attempting to seek funding for HIV prevention
efforts. Continue to offer HIV testing and counseling. Continue
to work with community based groups to address HIV issues.
GRAHAM
DHS HIV public relations staff send informative and educational
articles for publication in local newspaper. Until the numbers
require more than the inter-agency coordination with Cochise County
health educator, no plans to expand our current offerings.
GREENLEE
Plans to provide HIV education to staff on an annual basis.
MARICOPA
Plans to develor, an HIV Clinic to provide health care to both
asymptomatic ani symptomatic indivi~uals, including dental and
psychiatric services. Services to be coordinated with CBO's
providing case management.
NAVAJO
Plans to continue coordinating with other organizations.
PIMA
Planning in collaboration with other groups in Pima County to
develop, a screening clinic where asymptomatic HIV infected persons
can monitor their health. The services of such a clinic would
include physical examinations with immune system monitoring,
psychosocial support services, behavioral counseling and support,
and referrals to other resources in the community. Planning for
the expansion of existing services, particularly HIV Counseling and
Testing, to better address the needs of our clients. Other special
projects/interventions with high risk populations or segments of
our community are anticipated.
PINAL
Developing a speaker bureau to offer educational services to
interested agencies. Coordinating Arizona AIDS Education Breakfast
Meeting to provide for interagency networking.
YAVAPAI
Developing a community coalition.
VI. PRIORITY LIST OF OVERSIGHT COMMITIEE
RECOMMENDATIONS
MINORITIES AND HIVIAIDS
CURRENT STATUS
STATE AGENCIES
DEPARTMENT OF HEALTH SERVICES
Funds four community outreach programs in minority communities.
The 1990-91 funding for AIDS education and training programs from
CDC totaled approximately $157,000 awarded to: Central Navajo AIDS
Coalition; Indian Community Health Services; Pascua Yaqui Tribal
Health Department; and Southminster Social Service. Minority
contracts are now written and supported for 2 year periods,
allowing time for planning, implementing, and evaluating education
programs. Since 1987, the Department has requested additional AIDS
education funding for persons at increased risk for HIV, including
minority groups. However, to date, no additional funding has been
provided for this purpose. The Office of the Director has
initiated an DHS Working Group to review health data on ethnic
minority populations in Arizona and to identify problems in the
health status of ethnic minorities. To date information on
minority health status is quite limited. Current DHS
seroprevalence studies and surveillance data do not demonstrate the
need for a comprehensive epidemiologic study of HIV/AIDS among
minorities. Seroprevalence studies are in fact being conducted
among clinic populations representing primarily minority
populations. DHS is cognizant of the need for additional financial
and human resources in order to address the prevention needs of the
minority communities. DHS currently provides $157,000 in federal
funds for AIDS education in minority comunities.
DEPARTMENT OF HEALTH SERVICES - OFFICE OF PLANNING AND HEALTH
STATUS MONITORING
Monitors health status trends of Arizona residents with respect to
natality, mortality and morbidity. Of special interest is the
collective population of ethnic minority residents who represented
25 percent of the State's population in 1980 and have grown to
approximately 33 percent in 1990. Available information is limited
but does raise concerns for the health status of ethnic minorities.
A health status perspective of minority health will be expanded by
DHS in order to more fully understand and respond to the special
health concerns of ethnic minorities i

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STATE OF ARIZONA
GOVERNOR'S TASK FORCE ON AIDS
DECEMBER 1990
PROGRESS REPORT
ROSE MOWORD
Governor
Governor
J,,,,,
Chair
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STATE OF ARIZONA
GOVERNOR'S TASK FORCE ON AIDS
December 11, 1990
The Honorable Rose Mofford
Governor of the State of Arizona
The State Capitol
Phoenix, Arizona 85007
Dear Governor Mofford:
I am pleased to deliver the Oversight Committee Report of your Task
Force on AIDS. This Committee began in January, 1990 to monitor
the State and community response to the comprehensive plan
generated by the Task Force on AIDS.
This report examines the legislative impact of HB 2173, the AIDS
Omnibus Bill as well as recommending future legislative strategies
that will further Arizona's response to HIV disease. The Oversight
Committee is pleased to report that HB 2173 represents a
progressive policy response for our state.
The analysis and recommendations contained in this report resulted
from extensive review and data collection from state agencies and
community based groups. The recommendations set forth in this
document further refine the 1989 Task Force Report.
The Oversight Committee recognizes that these recommendations are
very encompassing. In this document and the prior Task Force
Report we recommend a great deal, recommendations that will cost
money, and will change the response to HIV within the state of
Arizona. The Oversight Committee acknowledges that not all will
get done. This is a plan, a working document. We hope that policy
makers will respond to this plan and utilize what is feasible,
affordable and shape the response to HIV within this state.
3008 North Third Street, Phoenix, Arizona 85012 (602) 230-5818
The Honorable Rose Mofford
Governor of the State of Arizona
Date
Page 2
This document, when used jointly with the 1989 Task Force Report
represent both a long range strategy and evaluation of early
implementation of this plan. The task ahead is to continue to
evaluate and plan the implementation of these recommendations.
This will require additional input and the Committee has
recommended a HIV Planning Council to be an ongoing entity to
forward this process.
This report represents a tremendous amount of input from state
agencies, community based organizations, and citizens whose lives
are affected by HIV disease. Their work and contributions have
been invaluable to the work and progress of this Committee and I
thank them. We urge you to appoint an HIV Planning Council to work
with policy makers in Arizona, and to implement a state strategic
plan.
Sincerely,
' Jane Aiken
Chair Co-Chair
TABLE OF CONTENTS
PAGE
LETTER OF TRANSMITTAL ............................... i
LIST OF OVERSIGHT COMMITTEE MEMBERS .................... iii
I . EXECUTIVE SUMMARY ........................................ 1
I 1. OVERVOIEVWER SIGHT COMMITTEE ACTIVITIES ......................5 ............................. HIV AND AIDS IN ARIZONA 9
I11 . LEGISLATION
LEGISLATIVE SUMMARY AND RECOMMENDATIONS ............ 17
PROPOSED AIDS RELATED ADMINISTRATIVE RULES ......... 22
I V - COST DATA ANALYSIS
INTRODUCTION ....................................... 24 ANALYSIS ...........................................2 5
INSURANCE COVERAGE AND COBRA ..................... 25
1991 FEDERAL FUNDING ............................ .26
CSUPRERCETNRTU M CODFC FSUENRDVIINCGE S. ..........................................................23 71
MINORITY PROGRAM FUNDING ......................... 35
COMPREHENSIVE PLANNING ........................... 35
SUMMARY OF PROGRESS REPORTS
STATE AGENCIES ..................................... 39
COUNTY HEALTH DEPARTMENTS .......................... 63
V I , PRIORITY LIST OF OVERSIGHT COMMITTEE RECOMMENDATIONS
MINORITY ISSUES e m . . . . . . . . . . . . . m . . . . . . . . . . . . . . w . . . 67
GAY AND BISEXUAL MEN ............................... 76
HIV/AIDS AND CHEMICAL ADDICTION .................... 80
MENTAL HEALTH ...................................... 84
ADVANCES IN TREATMENT .............................. 87
INSURANCE .......................................... 90
WOMEN AND HIV/AIDS ................................. 91
CORRECTIONS ........................................9 6
CASE MANAGEMENT ................................... 100
LONG TERM CARE .................................... 104
FELLOWSHIP PROGRAM ................................ 107
RURAL AREAS ....................................... 109
COALITIONS ........................................ 112
V I I . RECOMMENDATIONS FOR HIV PLANNING COUNCIL 118
V I I I . APPENDICES
OVERSIGHT GOQRDINATING COMMITEE MEMBERS
JAN KENNEY, Co-Chair
8908 West Vogel Avenue
Peoria, Arizona 85345
(H) 878-5142
JANE AIKEN
Professor of Law
ASU School of Law
Tempe, AZ 85287
(0) 965-6463
(H) 966-6674
WAYNE AERNI
2545 East Garnet
Mesa, Arizona 85204
(0) 892-1525
RON BARNES
Arizona AIDS Information Line
1110 East Turney
Phoenix, Arizona 85014
(0) 234-2752
CHRISTOPHER BROWN
AIDS Program Coordinator
Pima County Health Department
150 West Congress, Room 334
Tucson, Arizona 85701
(0) 740-8315
RUDY BUST TE, M.D.
Deputy Chief of Pediatrics
Indian Medical Center
4212 North 16th Street
Phoenix, Arizona 85016
(0) 263-1200 (X1551)
CYNTHIA CHENEY RON., J . D .
Crampton, Woods, Broening and
Oberg
1122 East Jefferson
Phoenix, Arizona 85034
(0) 271-7722
BENNIE CLICK
Assistant Police Chief
phoenix Police Department
620 West Washington Street
Phoenix, Arizona 85003
(0) 262-6747
ELLOUISE COYNE
Sickle Cell Anemia Society of
Arizona
1818 S. 16th Street
Phoenix, Arizona 85034
(H) 561-0683 (0) 495-5193
JOHN DACEY
Attorney
Gammage & Burnham
2 North Central Avenue, 18th
Floor
Phoenix, Arizona 85004
(0) 256-0566
(H) 254-2580
SUE DODD, R.N.
Director
Arizona AIDS Project
919 North 1st Street
Phoenix, Arizona 85004
(0) 420-9396
MELVIN HARRISON
Central Navajo AIDS Coalition
Box 2164
Chinle, Arizona 86503
(0) 674-5223
SCOTT JACOBSON
Director of Community Affairs
Arizona Public Service
Post Office Box 53999
Phoenix, Arizona 85072-3999
(0) 250-2264
BETTY KERR
1035 West Fairway Drive
Mesa, Arizona 85201
(H) 969-7622
CHUCK MAYER
1027 East Halcyon Road
Tucson, Arizona 85719
(H) 293-6315
(0) 322-9808
JOHN MILLIKIN
Vice President
Motorola Corporation
5005 East McDowell Road,
Phoenix, Arizona 85008
(0) 244-3781
SHARON NELSON, R.N.
Cullen Building
Saint Joseph's Hospital
350 West Thomas Road
Phoenix, Arizona 85013
(0) 285-3955
(H) 843-4524
LINDA SIMMONS-PARSON
Project Coordinator
Greater Phoenix Affordable
Health Care Foundation
326 East Coronado
Phoenix, Arizona 85004
(0) 252-5890
ERNEST SIMON, M.D.
Executive Vice President
Blood Systems, Inc.
6210 East Oak Street
Scottsdale, Arizona 85252
(0) 946-4201
JULIA SOT0
Director of Patient Services
El Rio Santa Cruz Health Center
839 West Congress
Tucson, Arizona 85745
(0) 792-9890
DOROTHY TOMLIN
Director
Pinal County Health Department
188 South Main
Coolidge, Arizona 85228
(0) 723-9541
JULIE MARSHALL
AIDS Project Coordinator
3008 North 3rd Street
Phoenix, Arizona 85012
(0) 230-5818
GEOFFREY E. GONSHER
Special Assistant
Office of the Governor
State Capitol - West Wing
Phoenix, Arizona 85007
(0) 542-4331
LAURA MARISCAL
Clerk Typist I1
AMY BURGER
University of Arizona
Summer Intern
SHERRY ANDERSON
Secretary
THE GOVERNOR'S TASK FORCE ON AIDS
OVERSIGHT COMMITEE
EXECUTIVE SUMMARY
In December 1989, the Oversight Committee was formed. The charge
to the committee was to advocate for and evaluate the state and
community response to the comprehensive plan generated by the
Governor's Task Force on AIDS. The Oversight Committee's work
initially focused on advocacy for the passage of legislative bills
which supported the Task Force recommendations. The second half
of the work of the Oversight Committee was devoted to an evaluation
of the state's movement toward the recommendations made by the full
Task Force and identification of the obstacles to progress.
In the past year several important events have occurred to move
Arizona forward in implementing the strategic plan outlined by the
Task Force:
* Passage of HB 2173, the AIDS Omnibus Bill, which addresses a
broad range of areas including confidentiality, workman's
compensation, victim's rights, and insurance issues. This
bill represents a forward move for the state.
* Passage of HB 2352 which establishes expedited placement and
adoption for children with HIV disease.
* Regulatory proposals, to address implementation of HB 2173,
have been drafted by the Department of Insurance and the
Industrial Commission.
* The Department of Health Services passed rules and
regulations to ensure the continuance of anonymous testing and
emergency rules to address informed consent.
* The Department of Health Services has recently been awarded
funding to provide services in the area of home health care
for persons living with HIV disease.
* There has been a statewide growth in HIV/AIDS coalitions for
both coordination and seeking of funding.
* The majority of state agencies reported that HIV education
has either been undertaken or plans are underway to address
this area.
With the passage of the AIDS Omnibus Bill, Arizona is moving from
concerns about issues of confidentiality toward resource and
service concerns. During the past year the committee has noted a
decline in community based organizations nationally who have
provided care and prevention services for those affected by HIV.
The State of Arizona has also experienced this national trend with
the closure of three major community based HIV projects. The
Oversight Committee recommendations have identified three areas of
concentration forthe future of HIV policy and program development.
PLANNING FOR THE EFFECTlVE USE OF RESOUFUES
During the course of evaluating the agency and community response
to the 1989 Task Force Report the issue of planning repeatedly
emerged, especially as this planning focused on the use of
resources. This report outlines areas where planning and further
community input can be beneficial to the State of Arizona. These
areas include:
* Mechanisms to fund county health departments using criteria
that acknowledge the differences between regions of this
state and their need for HIV treatment and prevention
efforts.
* Effective program development to address HIV prevention and
treatment issues in ethnic minority communities.
* Programmatic development for specific needs and challenges in
addressing populations including gay/bisexual, women and
children, minority, drug and alcohol users, and chronically
mentally ill.
* Development of effective and compassionate services for
individuals living with HIV disease that require funding and
coordination by appropriate state agencies.
* Decreasing the over-reliance on federal funds through
additional funding from local, state, and private resources.
* Additional community input via work groups and Task Forces to
address specific areas including: development of an Office on
Minority Health, Advisory Committee of Law Enforcement
agencies, Case Management Work Group, and Long Term Care Task
Force.
To assist with the development of planning and coordination issues
the Oversight Committee has two clear recommendations that should
be given immediate priority. The first is the creation of an HIV
Planning Council to address policy and programmatic issues and the
implementation of the strategic plan. The second is to address the
area of state appropriations for HIV programs. Both of these
recommendations are critical to the development of programs and
plans to meet the future of Arizona's citizens whose lives are
affected by HIV disease.
IMPROVING EDUCATION AND PRRlENnON EFFORTS
The Task Force addressed the area of HIV school based education
last year with a mandatory HIV education bill. This bill was
amended to dilute the public health intent of the bill and
subsequently died in committee. The Oversight Committee believes
that this bill needs to be reintroduced during the next legislative
session.
Additionally, the AIDS Omnibus Bill contained language, as
originally drafted, that would have required mandatory one time
education for licensed health care professionals. This bill was
amended in the Senate and this section was deleted. The Oversight
Committee has heard from numerous individuals and groups that this
concept continues to be needed. The Oversight Committee believes
that this issue should be revisited.
The Oversight Committee has recommended development of education
that will reach rural health care providers, and provide a
consultative network for physicians to use.
In the area of education and prevention, there is a pressing need
for efforts directed toward specific populations, including
gay/bisexual men, women, adolescents, and IV drug users. The
committee heard from community groups who were developing new and
creative programs. New approaches include using consortium models,
outreach models, peer models, and empowerment models. The
committee also saw and heard about problems with lack of services,
lack of adequate funding, and lack of coordination. Education and
prevention efforts are crucial to the state in order to stop the
spread of HIV disease. Current prevention efforts in this state
rely mainly on federal funding. Such reliance is inadequate and
short-sighted. For every HIV case we are able to prevent now, we
will decrease the suffering and costs for many in our state.
ENSURING ADEQUATE ENT
Treatment and services for persons living with HIV disease
represent a concern reflected in both reports. Treatment issues
include the provision of appropriate services that are accessible
and provided by health care personnel who are HIV knowledgeable.
The committee recommends the following:
* Legislation that will provide for the state payment of COBRA
premiums to maintain private health insurance benefits. This
policy change should be examined and criteria developed that
will address this area for persons with catastrophic need
that includes but is not limited to HIV disease.
~r State funding for treatment and care provision. To not
provide treatment may prove more costly in the long run for
our state.
* Development of a fellowship program to address the needs of
physicians in gaining education and training in the treatment
of persons with HIV disease.
* Assurance that health care providers through the state AI-ICCCS
plans are HIV knowledgeable.
* Service coordination through a case management system has
proven efficacious in order to improve services and address
cost containment issues. Case management within this state
is in early development and further work, coordination, and
studies are recommended to advance this area.
The Oversight Committee Report has taken considerable time, effort,
and research to determine whether Task Force recommendations are
moving forward in both state agencies and the community. The
Committee received over forty written reports, as well as numerous
verbal reports, regarding the recommendations from the 1989 Task
Force Report. The committee is indebted to those individuals,
groups, and agencies who responded to the request for information
and data. The Oversight Committee is acutely aware of resource and
budgetary restraints faced by our state. Recommendations have been
developed to address resource and funding issues. The report
suggests further legislation, consideration of new policy areas,
program development, and service delivery systems. All
recommendations included in this Report were approved unanimously.
The Report has built upon the 11989 Task Force Report and this
report represents a further refinement of the initial
recommendations. The Committee, in not restating the original
recommendations, recognizes that the new recommendations do not
replace or de-emphasize the original report recommendations. This
report and the long term strategy outlined assist Arizona to move
forward in a cost-effective and compassionate manner to serve the
citizens whose lives are impacted by HIV disease.
OVERSIGHT COORDINATING COMMITEE
In November of 1989, the Governor's Task Force on AIDS submitted
a full report to Governor Mofford, which included over 100
recommendations addressed to state agencies, county health
departments and community based organizations. Upon acceptance of
the report the Governor selected a twenty one member Oversight
Committee to monitor the progress of the Task Force recommendations
addressed to State Government Agencies and other organizations.
The Committee was also charged with monitoring the status of
proposed AIDS legislation and producing a final progress report.
The committee membership includes thirteen members of the standing
Task Force and eight additional members who sewed previously as
resource people to the Task Force. The members were assigned to
participate in sub-committees, covering legislation, policy, and
costs.
The Oversight Coordinating Committee participated in a number of
important activities, including:
* The Junior League of Phoenix AIDS Symposium and luncheon,
with guest, former Surgeon General Dr. C. Everett Koop.
* The 1990 Legislative session supporting proposed AIDS
legislation recommended by the Governor's Task Force On AIDS.
* "Broadcasters Respond To AIDSw briefing organized by
Communications Technologies of San Francisco for the Phoenix
Chapter of the National Association of Broadcasters.
Oversight Coordinating Committee members took part in the
coordination of this event, and the panel discussion.
* The National Parents Council on AIDS, annual meeting, with
members of the Oversight Coordinating Committee as speakers
and panel participants.
* AIDS Coalitions, newly formed in response to the Task Force
report recommendations and concerns.
The Oversight Coordinating Committee worked closely with the
Department of Health Services, coordinating strategy and developing
position papers on proposed legislation. The committee also worked
with DHS to assure participation in the public hearings on DHS
rules regarding anonymous testing and school notification. The
Committee requested progress reports from state government
agencies, county health departments and community organizations.
The following progress reports were received from:
State Auencies
Arizona Health Care Cost Containment System (AHCCCS)
Department of Corrections (DOC)
Department of Economic Security (DES)
Department of Education (DOE)
Department of Health Services (DHS)
Department of Insurance (DOI)
Department of Public Safety (DPS)
Arizona Disease Control Research Commission
County Health Departments
Maricopa County HRSA Case Management System
Pima County HRSA Planning Project
Apache County Mohave County
Cochise County Navajo County
Coconino County Gila County
Greenlee County Pima County
Graham County Pinal County
La Paz County Santa Cruz
Maricopa County Yavapai County
Yuma County
Communitv Based Oruanizations
Arizona AIDS Information Line
Arizona AIDS Project (AAP)
Central Navajo AIDS Coalition
CODAC
Community Organization For Drug Abuse Control
CODAMA
Community Organization For Drug Abuse Mental Health And
Alcoholism Services
Concilio Latino De Salud
COPASA
Community Outreach Project On AIDS In Southern Arizona
Greater Phoenix Affordable Health Care Foundation (GPAHC)
Hemophilia Association
Indian Community Health Services
Inter Tribal Council Of Arizona
Junior League Of Phoenix
National WARN Project
People with AIDS Coalition of Tucson
Phoenix Shanti Group
Phoenix Urban League
Planned Parenthood Of Central And Northern Arizona
Planned Parenthood Of Southern Arizona
Tucson AIDS Project (TAP)
Tucson Minority Consortium
University Of Arizona AIDS Education Program
During the review of progress reports and identification of work
accomplished by both state agencies and community based
organizations the Oversight Committee selected thirteen priority
areas for additional attention. This does not represent a de-emphasis
of the other recommendations in the 1989 Task Force
report.
The Oversight Committee acknowledges that their first six months
of work focused, by necessity, on the passage of House Bill 2173
and the legislative process which required a concentrated effort
by Oversight Committee members and a broad base of community
representation.
The Oversight Committee worked in groups to refine those areas
covered in this report in order to develop further recommendations.
Additional information was gathered by committee members who
personally contacted or worked with state agencies and community
based organizations to ensure accuracy of facts represented in this
report. The Oversight Committee worked throughout the summer to
gather and analyze information for the report. The Committee of
the whole met twice in the fall to review the documents and
recommendations. Final recommendations, after revision, were voted
on by the Committee. Committee members unanimously approved
recommendations. The Report recommendations represent the critical
concerns addressed by the Committee during the past year.
Oversight Coordinating Committee
February 1990 - October 1990
Meeting Schedule
Office of the Governor
1700 West Washington Street
Phoenix, Arizona
8th Floor Conference Room
February 9, 1990
March 9, 1990
April 11, 1990
Basement Conference Room
May 9, 1990
June 13, 1990
September 12, 1990
September 26, 1990
October 2, 1990
Arizona Department of Health Services
1740 West Adams
Phoenix, Arizona
Conference Room A, Fourth Floor
October 16, 1990
HIVIAIDS IN ARIZONA
The HIV and AIDS epidemic continues to worsen in Arizona. A total
of 1,262 cumulative cases of AIDS had been diagnosed and reported
in Arizona by October 1, 1990. An additional 363 cases of AIDS
Related Complex (ARC), 2,482 identifiable HIV-positive test
results, and 601 anonymous HIV-positive test results (anonymous HIV
tests are not included statistically with confidentially reported
HIV tests in order to avoid duplication) had been diagnosed and
reported by October 1, 1990. Overall, 60 percent of Arizonans
diagnosed with AIDS have died.
Although some leveling of the rate of the initially exponentially
increasing epidemic has been seen, each year's annual AIDS cases
continue to exceed those of the previous year. In 1989, 308 new
cases of AIDS were diagnosed, compared to 279 cases in 1988 and 255
cases in 1987.
Arizona continues to rank 22nd among states in the total number of
AIDS cases: however, Arizona's AIDS case rate over the past year
(September 1989 - August 1990) of 10.5 per 100,000 population
exceeds those of some other states with greater cumulative numbers
of AIDS cases such as Illinois (9.7 per 100,OOD) and Pennsylvania
(9.6 per 100,000). Over the same time period, the rate per 100,000
population in metropolitan Phoenix (13.5) and Tucson (9.6) compare
remarkably to large urban areas often thought of as having a
significant AIDS caseload such as Chicago (15.1) and the suburbs
of Los Angeles of Anaheim (15.1) and Riverside/San Bernardino
(10.3). These rates in Phoenix and Tucson exceed the rates seen
in the urban cities of Detroit (8.5) and Pittsburgh (6.8) . The
most current rate of 13.5 per 100,000 population in Phoenix exceeds
the annual case rate of 11.6 per 100,000 seen in Los Angeles during
the calendar year 1985, less than five years ago.
The largest concentration of diagnoses of AIDS occurs in the 30-39
year age group. National studies indicate that the average length
of time from infection with HIV to development of AIDS is 10 years
or longer. Thus, it is not surprising that the highest
concentration of diagnoses of ARC and asymptomatic HIV infection
include individuals in their twenties as well as their thirties.
AIDS cases continue to be overwhelmingly male. The male-to-female
ratio of AIDS diagnoses is 24 men to 1 woman in 1989. Fewer women
were diagnosed with AIDS in 1989 as compared to 1988. Women
represent about 10 percent of the HIV asymptomatic cases reported.
Of women who are HIV infected about half report IV drug use as the
risk factor and one third report heterosexual contact. Since 77
percent of all women reported with HIV infection are between the
ages of 20 and 40 potential exists for perinatal HIV infection in
this group.
The following Fisure 1 examines HIV cases, including ARC and AIDS,
by risk behavior:
ARIZONA HIV INFECTIONS
BY TRANSMISSION GROUP
Transmission Group AIDS
--
Gay or Bisexual Men 823
IV Drug User 94
Gay/lV Drug User 134
Hemophiliac 2 1
Heterosexual Contact 29
Transfusion with Blood 49
Parent at Risk or w/HIV 3
Other/Unknown 49
- --
TOTAL 1203
ARC HIV+ TOTAL (%)
* 24% had unknowdother risk, not included in (%)
As of 06/30/90 ADHS orfios of HIV/AIDS Services
FIGURE 1
Of the 1,262 AIDS cases, 1,066 (84 percent) were White, compared
with 126 (10 percent) Hispanic and 50 (4 percent) Black. Using
1980 census data, these represent cumulative rates per 100,000
population of 52.6 among Whites, 28.6 among Hispanics, and 68.2
among Blacks. Importantly, the AIDS incidence rate among Blacks
has been increasing rapidly in relation to rates among Whites and
Hispanics.
Arizona AIDS cases when evaluated for risk behaviors found within
ethnic categories shows: Fiaure 2
ARIZONA AIDS CASES: PERCENTAGE
BY RISK BEHAVIOR WITHIN RACE/ETHNICITY
WHITE BLACK HISPANIC
N = 1015 N = 48 N = 121
n GAY/BISEXUAL n IV DRUG ABUSE
TRANSFUSION GAY/IVDA
As of 06/30/90 OTHER ADHS Office HIVIAIDS Servtces
FIGURE 2
This data is significant due to the changes in the risk behavior
of IV drug use and gay/bisexual. Fully one fourth of Blacks with
AIDS report IV drug use as the probable mode of transmission,
whereas Hispanics report 12 percent and whites report 6 percent.
Obviously there is a implication for outreach and intervention.
The following Fisure 3 summarizes HIV infections by Race/Ethnicity:
Arizona HIV Infections
Race Specific Rates
By Year of Report
RATE PER 100,000 POP.
WHITE BLACK HISPANIC NATIVE AMERICAN ASIAN
RACE\ETHNICITY
*As of 07/31/90
FIGURE 3
Geographically, the largest concentration of AIDS cases continues
to be in Maricopa County, followed by Pima County. However, all
counties have reported at least one case of AIDS. The following
Table 1 and Figure 4 summarize data reflecting the impact of AIDS
on the counties within Arizona. Maricopa County continues to
report increases in numbers of AIDS cases.
ARIZONA HIV INFECTIONS
By County of Residence
COUNTY AIDS ARC HIV TOTAL
APACHE 5 1 2 8
COCHISE 9 6 42 57
COCONINO 8 - 15 23
GILA 4 - 3 7
GRAHAM 3 2 3 8
GREENLEE - - - -
LA PAZ 3 1 6 10
MARICOPA 891 295 1514 2700
MOHAVE 11 - 24 35
NAVAJO 4 - I 5
PIMA 222 35 475 732
PINAL 11 2 22 35
SANTA CRUZ 2 1 3 6
YAVA PA I 13 - 22 35
YUMA 15 5 49 69
UNKNOWN 2 6 289 297
TOTAL 1203 354 2471 4028
As of 06/30/90 ADHS Office of HIV/AIDS Services
TABLE 1
Arizona AIDS Cases
Cases by Rural and Metropolitan Counties
by Year of Diagnosis
Cases
MARlCOPA PlMA RURAL UNKNOWN
As of August 31, 1990 ADHS Office of HIV/AIDS Services
FIGURE 4
Homosexual and bisexual men have continued to comprise a majority
of reported AIDS cases in Arizona (see Figures 1 and 5). HIV
seropositive case data reported to the Arizona Department of Health
Services (ADHS) suggest that this trend will continue, since
homosexual and bisexual men comprise 71 percent of those reported
with asymptomatic HIV infection (see Figure 2 and Figure 5).
AIDS cases diagnosed among intravenous drug users have been
increasingly reported. In 1988, 12 percent of all cases claimed
intravenous drug use as their sole risk behavior. This compares
to 6 percent claiming the same in 1985. This increase raises
concerns that increasing HIV infection among intravenous drug users
may accelerate the spread of HIV infection into the heterosexual
population. Data from an on-going blinded HIV seroprevalence
study, being conducted by ADHS in two Phoenix drug treatment
centers, indicate that the current level of HIV infection among
intravenous drug users seeking treatment is low, around 3 percent.
Similar studies in New York and New Jersey have found much higher
rates among intravenous drug users, some in excess of 50 percent.
This suggests that timely prevention efforts among intravenous drug
users may avoid high infection rates.
Arizona HIV Infection
Percentage by Risk Behavior
and Year of Report
Percent
1
-
Gay Gay/lVDU IVDU Blood* Hetero Other Unknown
Risk Behavior
Includes hemophilia and transfusions
AS of 07/31/90 ADHS Office of HIVIAIDS Services
FIGURE 5
Utilizing estimates and projections of the Centers for Disease
Control, and comparing local HIV seroprevalence rates to other
regions of the country in this regard, the Arizona Department of
Health Services (DHS) has made estimates and projections for
current and future cases of HIV-related disease in Arizona.
Currently, DHS estimates that approximately 10,000 -20,000
Arizonans are infected with HIV. By the end of 1993, DHS expects
a cumulative total of 3,120 - 3,840 Arizonans to have been
diagnosed with AIDS.
Given the level of HIV infection already present in the community,
and the long time course from infection to AIDS, Arizona will
continue to feel the effects of HIV-related disease for many years
to come.
LEGISLATIVE SUMMAFW AND RECOMMENDATIONS
BACKGROUND
Arizona's Legislature considered nearly a dozen bills during the
1990 spring session which dealt with issues directly affecting HIV
infected persons or directed toward preventing further spread of
the disease. One bill, House Bill 2173, researched and drafted by
the Task Force and sponsored by Representative Susan Gerard, was
signed into law in June 1990. Another House Bill, HB 2352,
provided for expedited placement and adoption of HIV positive
children, was signed into law by the Governor in April 1990. The
remaining bills considered by the Legislature all failed ultimately
before reaching the Governor's desk.
AIDS OMNIBUS BILL
House Bill 2173, frequently referred to as the AIDS Omnibus Bill,
addresses a variety of public health and social policy issues.
The Omnibus Bill creates a statutory structure for maintaining the
confidentiality of public health and other medical records and
promotes voluntary testing by mandating an anonymous testing
option. Testing is also encouraged by requiring informed consent
for an HIV test and for release of HIV related insurance records.
The worker's compensation portion of the bill establishes a
procedure which assures health care workers and others who acquire
HIV infections in the course of their employment, that worker's
compensation benefits will be available. The Omnibus Bill gives
victims of sexual assault and other crimes where there is a
potential for infection the right to access the convicted
offender's HIV test results. Other provisions aimed at further
reducing the spread of the disease include new statutory authority
for the Department of Health Services to establish procedures for
controlling infected persons who cannot or will not conform their
own behavior for the protection of others. The Omnibus Bill also
incorporates portions of a separate bill, SB 1044, which authorizes
the Director of Insurance to adopt rules concerning the
confidentiality of HIV information in the insurance setting. This
section of the Omnibus Bill also requires written informed consent
for HIV testing done during the insurance application process.
The new AIDS Omnibus Bill does not solve every problem or deal with
every medical issue related to the HIV epidemic. Nonetheless, the
State of Arizona has taken a large step toward aggressive,
comprehensive policy for dealing compassionately and intelligently
with HIV infected persons and protecting those who are not infected
from the disease. Perhaps more importantly the creation of this
bill proves that fair-minded, well-informed people from markedly
disparate sociopolitical perspectives can work together and reach
a consensus on how to combat the threat of HIV.
The Interaovernmental Health Policy Proiect. AIDS Policy Center at
Georae Washinuton University reports on significant and exemplary
AIDS-related program and policy initiations occurring within state,
county and municipal governments nationwide. During the summer of
1990 the project provided the Oversight Committee with this
analysis:
The AIDS Omnibus Bill is a remarkable accomplishment for the State of
Arizona. Arizona was one of the very few states that were able to take a
comprehensive approach to HN issues and pass omnibus legislation. Prior
to this legislative session, Arizona had lagged in its ability to cope with the
myriad problems associated with AIDS. The Act brought Arizona into the
mainstream with its legislative strategy for dealing with HN disease.
Arizona is now one of twenty states which require data in medical
treatment records to be confidential. Arizona is one of forty-four states with
worker notification laws and one of eighteen states that provide for some
kind of partner notification when there appears to a physician that there is
a need to warn such parties. The plan that Arizona developed is unique in
that it uses the expertise of the health department as a control so that such
notification is done sensitively and with minimal breach of confidentiality.
Arizona has instituted innovative insurance laws. It is one of sixteen states
that require informed consent before insurance HIV testing and one of
nine that require confidentiality provisions in insurance. Additionally,
Arizona is one of three states that has passed a law that will allow the
accelerated use of life insurance benefits. Clearly this legislation is a major
step forward in our fight against HN disease.
OTHER BILLS SUPPORTED BY TASK FORCE
The Task Force prepared two other bills which would have helped
stop the spread of AIDS, but neither of these bills survived
legislative scrutiny. House Bill 2361 would have required public
schools to include age appropriate information about AIDS in
health class curricula. Educating Arizona's children about AIDS
is one way the members of the Task Force agreed would protect the
next generation of adults from the risk of contracting HIV
infection. This bill passed the House of Representatives but was
amended by the Senate in such a way that the public health benefits
of the bill were eliminated. The AIDS school instruction bill did
not pass the conference committee.
Another bill recommended by the Task Force, HB 2222, did not deal
specifically with AIDS, but provided protection from discrimination
for all disabled Arizonans, This bill would have mirrored the new
federal Americans with isa abilities Act which expands legal
protection against discrimination in employment, transportation,
public accommodation and telecomunications for the disabled.
Preventing discrimination against disabled people, including those
with HIV infection, was another key recommendation made by the Task
Force for the purpose of encouraging voluntary testing.
Public health authorities, including former Surgeon General Koop,
have repeatedly stated that providing protection from
discrimination will have the positive public health benefit of
encouraging those who are infected to obtain testing and learn how
to protect others from infection. During the Task Force's final
deliberations on its recommendations to the Governor, the
representative fromthe Arizona Attorney General's office indicated
that the Attorney General would support precisely this type of
legislation to benefit HIV infected and all other disabled persons.
The Attorney General's office did not actively support this bill
when it was submitted to the House of Representatives.
A fair housing bill, Senate Bill 1150, was created independent of
the Governor's Task Force on AIDS. This bill would have provided
some protection from discrimination for disabled people, including
those who are HIV infected. Unfortunately, this bill, too, did not
pass committee. House Bill 2264 which introduced payments of COBRA
for persons diagnosed with AIDS was introduced and after a hearing
the Committee was referred to the Joint House and Senate Hearing
Committee.
BILLS NOT SUPPORTED BY TASK FORCE
Four other bills concerning AIDS issues were introduced during the
spring session but received little legislative support or
attention. House Bill 2128 would have required physicians to
attend continuing medical education concerning the benefits of
autologous blood donations. House Bill 2129 would have allowed
mandatory testing on persons accused but not convicted of sexual
offenses. HB 2330 (Senate version was SB 1304) would have mandated
testing of all prisoners and regulated certain aspects of applying
for health insurance. None of these bills were supported by the
Task Force because the AIDS Omnibus Bill dealt more completely and
effectively with these issues. In addition, certain aspects of
these three bills, particularly the mandatory testing provisions
of HB 2129, would have a negative effect on public health policies
and strategies designed to increase voluntary testing and decrease
the number of new HIV infections.
RECOMMENDATIONS
ANALYSIS: The Oversight Committee of the Task Force has four
primary recommendations for legislation in the upcoming legislative
session. Two of these are the same recommendations originally made
by the Task Force:
Age appropriate AIDS education in the public schools, as part of
the health cussiculum, is essential to protect the next generation.
Protection of disabled people from discrimination in the most basic
areas of daily life (employment, housing, transportation, public
accommodation, and telecommunications) is essential to the success
of public health efforts to test everyone at risk for HIV and
provide those who are infected with the information they need to
protect others from acquiring the infection.
The Oversight Committee has identified two more critical areas in
which legislation is needed. The Legislature must appropriate
funds to implement the public health strategies for prevention of
HIV infection. Education remains the most successful tool in
reducing the risk of acquiring HIV infection. Some important
aspects of education can be accomplished without significant funds.
For instance, HIV-related information can be added to school based
health programs. While funding will be required for other
programs such as outreach educational programs for drug addicts,
high school drop outs, and other people, many of them teenagers,
who cannot be reached through established institutions such as
schools or churches.
~ppropriation of funds is also significant in light of the Ryan
White federal legislation. This piece of legislation addresses two
major areas of funding that will impact Arizona: 1) Coordinated
direct services for AIDS, ie, case management, home and community
services and 2) Counseling, testing and early intervention.
The other area where legislation is urgently needed is in providing
adequate medical services for people with AIDS and other
chronically ill, uninsurable Arizonans. One relatively simple and
highly cost effective measure would be to adopt legislation which
allows the State to pay private health care insurance premiums.
This would ensure that those persons who qualify for COBRA will
receive medical care under a private insurance policy rather than
entirely at the expense of Arizona's indigent health care program.
The payment of COBRA premiums to continue private insurance should
be examined in a broader based model where catastrophic illness
criteria can be developed. To limit this program to AIDS is not
in the best interests of Arizona. Similar programs have been
developed in Texas, Connecticut, and California
There is no doubt that other appropriations will be necessary to
provide medical care and treatment for persons infected with the
HIV virus. The problems faced by people with HIV disease who do
not have private health insurance must remain a high priority for
the legislature. Allowing the State to take advantage of private
insurance policies available to some persons with HIV disease is
an important first step in solving those problems.
THE OVERSIGHT COMMITEE RECOMMENDS:
1. Reintroduction of a mandatory K-12 HIV education bill.
2. Reintroduction of a bill preventing HIV related discrimination
in employment, public accommodations, transportation and
housing.
3. Introduction of an Appropriations Bill to fund programs in
the areas of HIV prevention and direct care provision for
persons with asymptomatic and symptomatic HIV disease.
4. Introduction of a bill to continue payments to maintain
private insurance coverage. Criteria for eligibility should
be based on both fiscal need, uninsurable status, and
chronic/catastrophic health problem.
PROPOSED AIDS RELATED ADMINISTRATIVE RULES
DEPARTMENT OF HEALTH SERVICES
Initiated the process to amend administrative rules regarding
anonymous HIV testing, notification of school districts of HIV-infected
pupils, and confidentiality of communicable disease
information in November, 1989. The amendments regarding anonymous
HIV testing and confidentiality were necessary to continue the 18-
month emergency measures implemented by DHS in March 1989. DHS
held public hearings in June 1990 to address proposed rules on
anonymous testing, school notification and confidentiality. The
proposed rules were not drafted in concert with the proposed
legislative House Bill 2173. These rules were filed by the
Secretary of State on September 14, 1990. The Governorts Task
Force on AIDS, county health officers, medical and hospital
associations were notified of the conflicts by DHS and directed to
adhere to the provisions of the statutes in any conflicting areas.
(see Appendix 1)
At the time of the public hearing HB 2173 passed the Senate prior
to the last public hearing scheduled in Phoenix. For the public
record the Chairperson of the Oversight Committee requested a
response regarding the impact of the statutes on the proposed
rules. The response received indicated that although the rules
needed to be revised based on HB 2173 the rule making would
proceed.
Based on this response the Oversight Committee legislative
subcommittee met and reviewed the Rules and the process of rule
making. A letter to DHS dated August 8, 1990 addresses three major
areas where the rules are inconsistent, and in fact are over ridden
by HB 2173 (see Appendix 2). This letter summarizes the Oversight
Committee concern with the proposed rules. DHS responded to the
Oversight Committee letter in a letter August 23, 1990 (see
Appendix 3). The rules promulgated are in some places inconsistent
with the law and must be redrafted and put through the rule making
process. These rules were approved on September 14, 1990. DHS has
also promulgated a 90 day emergency rule detailing procedures for
obtaining specific, written and informed consent before HIV
testing. DHS is currently drafting rules for HB 2173. Hearings
should be held in the spring.
DEPARTMENT OF INSURANCE
Is promulgating rules currently. The rules will consist primarily
of the Department's current "AIDS guide lines^^ but will include
some additional modifications as may be required by the new law.
INDUSTRIAL COMMISSION
Is promulgating rules specific to the Workers Compensation
provisions of the law. They are currently gathering information
about necessary content of these rules. At this time the Oversight
Committee has indicated both the desire and willingness of members
to work with DHS on the proposal and drafting of rules for HB 2173.
COST DATA ANALYSIS
INlRODUCTloN
The costs of HIV disease not only affects specific government
agencies, hospitals, and insurance companies, but has an effect on
all aspects of society. Everyone will share the burden of the
costs of AIDS. The potential numbers in Arizona are truly
alarming:
~r The 1989 Report of The Governor's Task Force on AIDS included
a ten year forecast projecting that HIV/AIDS could cost
Arizona's health care system up to $750 million with the
state paying $225 million in direct costs for HIV disease
related health care.
* A 1989 study for AHCCCS completed by the ASU School of Health
Administration stated that total costs for treatment of
persons with HIV Disease to AHCCCS through 1992 range from
$24.6 million to $42.2 million. At the time of the report
AHCCCS was responsible for over 50% of all AIDS cases
reported.
* Local and national projections of AIDS cases indicate that
annual numbers of AIDS cases will continue to increase through
1993.
* Gathering accurate numbers and cost figures for HIV disease
in the state is a difficult task, making the development of
a long range plan even more uncertain.
The trend is obvious, ever increasing new HIV/AIDS cases,
increasing burdens on our state and local health agencies, our
hospitals and community based organizations. Arizona is considered
a second wave state, with other states such as California and New
York considered first wave states. This means that Arizona will
soon face similar strains to its health system. In fact major
cities in California and New York have been declared health care
"disaster areasw by Congress, thus qualifying them for desperately
needed special federal funds. Although the numbers are indeed
grim, many of these devastating costs can be avoided if a
coordinated long term strategy to deal with HIV disease in Arizona
is developed. There are several steps that if taken now can save
millions of dollars in the future.
ANALYSIS
INSURANCE COVERAGE AND COBRA PAYMENT8
Large numbers of persons with HIV disease are without health
insurance and eventually require state agency assistance at
significant expense to the state. Several states have undertaken
programs to assist not only HIV infected persons but other citizens
in maintaining private insurance. These states have found this to
be a cost effective and efficient way of allowing individuals to
receive medical treatment. One option being tried by states is a
program where the state pays health insurance premiums under the
COBRA plan. The COBRA plan allows an individual who has lost a
job to maintain at their own expense private insurance for a
minimum of 24 months. Frequently the person is unable to maintain
the insurance premiums due to fiscal problems and loses health
insurance coverage. When a major illness occurs, the individual
is unable to pay for the treatment eventually a state agency pays
the cost or it is picked up as charity care. With AIDS and other
serious illnesses this can create a tremendous burden not only on
the state health care budget, but also contributes to the growing
problem of uncompensated health care which threatens the financial
life of many community hospitals. If an individual qualifies under
this alternative program, the state pays the private insurance
premiums until the individual is able to once again pay their own
premiums. Although these programs are new, there are initial
indications that these alternatives are very cost efficient.
1. The state of Washington estimates $3.25 million in savings for
the fiscal year 1991, with $1.6 million saved in 1990. The
costs of care for persons with AIDS is $1,981 monthly, while
the average insurance premiums cost $150 per month.
2. The state of California has preliminary estimates of savings
of over $750,000 for the first five months of 1990.
3. Other states have just begun the program, with each state
setting up eligibility standards based on either total family
assets (usually less that $10,000) or a percentage of federal
poverty guidelines.
The Ryan White Act contains a provision for payment of COBRA to
maintain health insurance coverage. The Oversight Committee
recommends the payment of COBRA premium as an alternative to
maintain private health insurance. The costs of paying the private
insurance premiums for citizens far outweigh the costs of having
the state pay for expensive medical treatment. The growing number
of uninsured citizens who need medical care but have no health
insurance is a tremendous strain on our health care system in
Arizona. This problem will only be worsened by the increasing
number of persons with HIV disease who require expensive long term
medical treatment. It is in the interest of the state and the
taxpayers to see that every effort is made for these individuals
to maintain or have available private health insurance.
Implementing a program to assist these individuals is an
inexpensive alternative that can save the state dollars.
1991 FEDERAL FUNDING
During 1990 the Congress passed two significant pieces of
legislation. These Acts will affect the future federal funding
allocations available in Arizona as follows:
HEALTH OMNIBUS PROGRAMS EXTENSION (HOPE) ACT: In 1988 federal
changes authorized AIDS prevention funding on a formula basis
rather than a competitive basis. Since 1986 CDC has provided
funds through cooperative agreements to state health
departments. During 1990 the HOPE legislation failed to gain
an appropriation. Arizona was one of thirty five states who
would have faced decreased funding under the formula based
funding proposed. The proposed formula would have decreased
Arizona funding by approximately 20 percent. HOPE formula
funding was based upon the state's relative number of AIDS
cases and relative percentage in the total U.S. population.
This legislation would have effected the funding for program
categories including health education, minority initiatives,
public information programs and school based programs.
RYAN WHITE COMPREHENSIVE AIDS RESOURCES EMERGENCY ACT OF 1990:
The White legislation provides federal support for
comprehensive health and social services for people living
with AIDS and HIV disease. There are four areas of this ACT:
Title I provides emergency relief grants to meet the out-patient
and case management needs identified by planning
councils in localities disproportionately affected by the HIV
epidemic (does not include Arizona but covers 16 cities).
Title I1 provides grants to states for care consortia and
other programs to improve and increase availability to HIV
services. This title is an area where Arizona may apply for
funds in the following areas:
1. Establish HIV care consortia for a comprehensive system
of HIV services.
2. Provide hame and community based care services for
persons with HIV disease.
3. Provide assistance to assure continuity of health
insurance coverage for persons with HIV disease.
4. Provide treatment to economically disadvantaged persons
with HIV disease, including outreach to identify these
persons.
Title 111 provides grants to states and public/private
nonprofit clinics receiving grants administered by HRSA for
HIV antibody counseling and testing, diagnostics, and early
intervention treatment and referral. Arizona will be eligible
to apply for this funding along with HRSA administrated
clinics. In the future this funding may take over for current
CDC HIV antibody testing and counseling monies and expand the
area of early intervention.
Title IV is a broad area containing a number of provisions
including Pediatric AIDS research demonstration, special
studies, and provisions for emergency response employees.
Appropriations for the Ryan White Act were passed by Congress
in late October for $226 million, with no forward funding
beyond FY91. This amount is far less than the original
authorized amount of $881.5 million. Funds appropriated do
not fund Title 4 of the Act but Titles 1, 2, and 3. It is too
early to determine the impact of this appropriation on future
Arizona funding.
SPECTRUM OF SERVICES AND COST OF PLANNING
The continuum of care for HIV disease ranges from asymptomatic
wellness based care to acute care, chronic care, and terminal care.
Although the Oversight Committee requested information from AHCCCS
regarding cost of care for their clients with HIV the data was not
available at the time this report was drafted. It is estimated
nationally that Medicaid systems are the responsible payor for 50-
60% of all chronic and terminal care by national reports. Although
the bulk of money spent on home care comes from Medicare, few
persons with AIDS qualify for Medicare.
In order for Arizona to be diligent in addressing both the spectrum
of services and cost of planning to provide these services, there
must be an effort to correlate and study in-state data. AHCCCS is
a key player since they have current data and are heavily affected
by potential costs. Research and evaluation should address:
* What are the current and projected needs, demands,
utilization patterns and costs of the components of HIV care
on a continuum?
* Can longitudinal studies of cohorts of HIV-infected
individuals be developed to identify ranges of services and
resources needed and utilized?
* How can case management systems impact accessibility,
quality, and cost of care issues?
* What is the projected effect of early intervention treatment
and monitoring on the course of HIV disease?
* What are the comparative cost and outcomes of care in
respective community settings and how do these compare with
institutional settings?
This represents the foundation for building a strategic plan for
addressing HIV/AIDS research in Arizona. In order to accomplish
this review and research, leadership must emerge. Likely leaders
within the state include AHCCCS and University of Arizona Health
Sciences Center.
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS)
Although AHCCCS was unable to complete cost data analysis on
enrollees with HIV disease by the deadline for this report they
were able to examine trends in enrollment and provider health plan
data.
Since January 1989, over the past 18 months,, enrollment of persons
with HIV disease in AHCCCS has doubled. This is reflected in the
number of cumulative patients enrolled monthly with AIDS. Fiqure
-1 shows the total numbers of AIDS patients served by AHCCCS (N =
700). For accuracy one must subtract the total deceased patients
(N = 308). Currently AHCCCS reports 154 person who are inactive
or not eligible for services. A portion of these may simply
require renewal of enrollment.
AHCCCS - TOTAL AIDS PATIENTS
CUMULATIVE REPORTED MEMBERS
J 8 9 F M A M J J A S O N D J 9 0 F M A M . J J A
SINCE 1989
OFFICE OF THE MEDICAL DIRECTOR
FIGURE 1
Fisure 2 indicates where persons with AIDS are enrolled for health
care. There are five major health plans who play a significant
role in provision of services. These are identified in the
following chart:
AHCCCS - AIDS ENROLLMENT
AS OF SEPTEMBER 1, 1990
I BY HEALTH PLAN I
MERCY
OFFICE OF THE MEDICAL DIRECTOR
FIGURE 2
As of September 30, 1990 the Arizona HIV Infection Surveillance
Report shows:
Number of AIDS cases
to 9/30/90
Number of AIDS cases
reported deceased
Number of AIDS cases
(excluding deaths)
Number of AIDS cases
(living) enrolled in
AHCCCS as of 9/1/90
AHCCCS data reflects 46 percent of persons diagnosed and reported
in Arizona with AIDS utilizing their services. This does not
include persons with symptomatic or asymptomatic HIV disease.
Additionally, not all AHCCCS cases are cases reported within
Arizona. It is clear based on this data that AHCCCS is a
significant provider of health care whose role is increasing
rapidly as demand for care increases.
CURRENT STATE FUNDING
Current appropriation to DHS for AIDS from the State of Arizona is
approximately $487,200. These funds are used to provide staff
positions to DHS and to contract funds to Maricopa and Pima
Counties for AIDS surveillance. DHS staff positions include:
Office of AIDS Manager; Public Health Nurse Consultant;
Statistician; Health Educator I; and Clerk Typist. The use of
these funds in FY 89/90 is summarized in Table 1:
ARIZONA DEPARTMENT OF HEALTH SERVICES
STATE FUNDED AIDS BUDGET*
JULY 1, 1989 - JUNE 30, 1990
Personnel $113,400
Fringe Benefits 30,000
In-State Travel 5,500
Out-of-State Travel -------
Other Operating 213,300
Equipment -------
Contractual 125,000
TOTAL $487,200
TABLE 1
No state funds are contracted for either HIV prevention or
education programs
$125,000 is subcontracted to Maricopa and Pima Counties for
surveillance activities.
The total Arizona State dollars is $487,200 (FY 89/90). Total
CDC dollars is $2,312,767 (FY 90); total HRSA dollars is
$356,162 for the AZT program and the home based care grant.
CDC FUNDPHQ
Over the past five years Arizona has received over $4.3 million
dollars from CDC. The distribution of these funds over the past
five years is summarized in Appendix 4. For the purpose of review
funds are broken down by county and include all funding within the
county, including funding to community based organizations. Data
summarized in Appendix 4 (Distribution of CDC AIDS Funding in the
State of Arizona, 1985-1990) demonstrates:
Department of Health Service (FY 1990) relies upon
$905,648 for 15 staff positions including salaries,
benefits, travel, and other operating expenses,
laboratory services, and administration. This is 39
percent of the 1990 CDC funding.
Funding to rural counties began in 1987 and has increased
each year. DHS stated that funding amounts to rural
counties is based on negotiated work contracts to fund
a position by staff hours. Funding to rural counties is
from funds available under counseling and testing.
During 1990 there was a decline in funding to community
based agencies and the local health department in
Maricopa County.
During 1990, DHS total funding from CDC decreased by
$21,713.
Current contractual funds from DHS utilizing CDC funds during FY
1990 is documented in Table 2, pp. 32-33:
DEPARTMENT OF HEALTH SERVICES
AIDS PREVENTION AND SURVEILLANCE FEDERAL FUNDING
1/1/90 - 12/31/90
**COUNSELING AND TESTING
*CODAMA
Cochise County
Coconino County
La Paz County
Maricopa County
Pima County
Pinal County
Santa Cruz County
*Terros
Yavapai County
Yuma County
SUB TOTAL
SEROPREVALENCE
Colorado State Lab
Maricopa County
SUB TOTAL
SURVEILLANCE
Maricopa County
SUB TOTAL
HEALTH EDUCATION
Coconino County
*CODAMA
Maricopa County
Maricopa County Info. and Referral
Pima County
Pima County Info. and Referral
Tucson AIDS Project
Unobligated
AMOUNT
SUB TOTAL
AMOUNT
Central Navajo AIDS
1ndian community Health
Pascua Yacqui
Southminster Social Service
SUB TOTAL
TOTAL CONTRACTUAL
TOTAL AWARD
TABLE 2
* CDC funds are contracted to minority community based
organizations and programs to reach IV drug users. Actual
funding to community based organizations totaled $191,273 (or
13 percent of total contracted funds).
** 93 percent of all counseling and testing money is directed to
county health departments.
Table 3 summarizes the CDC funding utilized within DHS including
administrative costs:
SUMMARY OF 1990 AIDS PREVENTION AND SURVEILLANCE
PROJECT FUNDING
PERSONNEL $ 386,547
Disease Prevention $ 331,895
State Laboratory 54,652
FRINGE BENEFITS $ 96,486
Disease Prevention $ 82,422
State Laboratory 14,064
TRAVEL $ 25,300
OTHER OPERATING COSTS $ 145,449
ADMINISTRATIVE COSTS (INDIRECT CHARGES) $ 239,213
Disease Prevention $ 210,654
State Laboratory 28,559
TOTAL
TABLE 3
Future federal funding through the Ryan White Act has a 5 percent
administrative cap. Current essential indirect costs for DHS
represent 10 percent of the appropriated funds. DHS will need to
examine the area of indirect costs in light of the Ryan White Act
in order to adjust for this funding format.
ADDITIONAL FEDERAL SOURCES OF FUNDING TO ARIZONA
Currently DHS receives funding from HRSA for the AZT program and
a separate amount for home and community based care. During 1990
HRSA awarded $126,000 for home and community based care to Arizona.
These funds will be utilized to address provision of services to
those who lack other payors for these services. The AZT program
has been in place for several years and provides AZT to those who
lack health care coverage to pay for this treatment. The total
funds received for these two combined programs from HRSA is
$356,162. In the future these funds may become a part of the Ryan
White funding mechanism.
MINORITY PROG FUNDING
State and federal funding to the Black and Hispanic communities
though ADHS , have been inadequate. The Task Force and the
Oversight Committee for two years has heard from these communities
regarding the lack of support. Fiscal allocations in the minority
section of this report reinforce this allegation. The review of
funding trends indicates that funds are not reaching communities
that are having a significant rise in the incidence of HIV. There
is no long range plan for programmatic intervention in minority
communities. There is no systematic needs assessment or strategic
planning to determine how best to use funds to build programs.
Instead the state relies on a funding process based on request for
proposals that is based on the procurement code.
Communities which are experiencing the greatest need may be least
likely to be able to respond effectively to this procedure. DHS
has the capacity and authority to provide technical assistance.
Such assistance should be aggressively given. Other states provide
technical assistance through their health department including,
identifying community needs, outreach to those communities
assisting in grant writing and evaluating the adequacy of
proposals. These technical assistants are insulated from the
decision making process on the proposals and allocation of funds.
There are simply not enough funds to go around. Funding does come
from a variety of sources, including CDC, HRSA, and others. ADHS
and minority groups should be working together to maximize these
resources.
The issue of funding for programs to target the Minority community
is addressed both here and in the Minority section. This issue is
extremely important to HIV prevention. The Oversight Committee
believes that past decisions on funding specific to the minority
community, although based on the RFP process, have not addressed
the development of programs to reach those at highest risk for HIV.
Later in this report the Committee addresses other gaps including
funding and programs for gay/bisexual men, women at risk, and IV
drug users. Changes recommended include increasing technical
assistance, development of a review and resubmit procedure, and
reexamination of the RFP process.
COMPREHENSIVE PLANNING
The Oversight Committee worked closely with DHS staff to review
funding patterns and history. During this review several issues
become apparent. Arizona HIV efforts have been driven by funding
sources. Instead of a proactive planning process, programs have
been developed to respond to the funding mechanism. This
frequently results in fragmented program development.
This problem has been compounded by the limited availability of
state funds through legislative appropriation process. Funding
available from the Arizona State legislature does not expand
current programs within the communities, nor does it allow for
development of programs in areas that are under funded by federal
sources. In reviewing our sister states experiences, state funding
is critical to not only the development of prevention and direct
care resources but also the continuance of demonstration projects
as federal funds diminish.
The future impact of the Ryan White Act on the State of Arizona
will need to be monitored closely. This legislation directs
funding through the Executive Branch of Arizona government, to DHS
and DOE, requires caps on administrative costs and requires the
state to have specific policies in place for receipt of funding.
Arizona may need state dollars to meet the current administrative
costs. This Act recommends procedures for public input or planning
prior to fund utilization. The Oversight Committee has reviewed
this Acts and is pleased to note that policy requirements of the
Ryan White Act have been addressed in the AIDS Omnibus Bill (HB
2173). his placed Arizona in a policy position to apply for these
funds .
In reviewing the disbursement pattern of current funds to local
health departments and community based organizations several issues
were identified. Funding to the two largest counties, Maricopa and
Pima, appears to be directed toward positions and not performance
standards. The difference in funding between these counties
appears to not be based on work required, i.e., number of HIV
tests, number of surveillance reports, etc. FY 1990 funds to
Maricopa County, excluding funding for the Family of Surveys for
CDC, exceed Pima County by approximately 25 percent. DHS
surveillance reports indicate that 74 percent of all AIDS cases,
and 69 percent of all asymptomatic HIV cases are reported in
Maricopa County. The decline in funding to the health department
and community programs within ~aricopa County seems short sighted
in light of epidemiologic trends.
Funding from DHS to rural counties has increased over the past two
years. Services within rural counties are expensive when compared
to either the number of AIDS cases or the number of HIV tests
performed . Rural counties express concern over issues of
networking, provider knowledge of HIV, and sewice for persons with
HIV disease. Current DHS funding is for counseling and testing
and not direct services for HIV infected persons. In major urban
counties those services are provided through community based
organizations who seek a broad base of funding. Arizona needs to
examine the funding to rural areas that will maximize the dollars
spent in light of services obtained. Rural partnerships and
linkages with community based organizations in urban areas many
prove beneficial to developing services for persons living with HIV
disease.
1. Arizona should begin to implement a program allowing state
agencies to subsidize private insurance premiums. At the same
time the state should also consider setting up a health
insurance risk pool as another reasonably priced alternative
to expensive state funded health care.
2. Arizona should use the opportunity, in light of the new
federal funding mechanism, to evaluate how AIDS dollars are
currently spent and how new dollars will be utilized. Ryan
White legislation requires long range planning and specifies
the type of funding, including caps on administrative costs.
Also recommended is an HIV Planning Council in the Governor's
Office, that is comprised of community members familiar with
the service needs. This Council will assist the state in
making effective long range plans.
3. Expanded availability of anonymous HIV antibody testing, as
well as other programs and services, in non-governmental
sites. Department of Health Services should direct increased
funding to community based organizations for both preventive
and therapeutic services.
4. Appropriate federal funds be utilized during the current
funding cycles. DHS will need to implement guidelines to
assure appropriate expenditure of funds due to restrictions
on carryover funding under the Ryan White legislation.
5. DHS, AHCCCS, and community organizations should begin to
address planning for utilization of funding for community and
home based care contained in the 1991 Ryan White legislation.
Such planning will be in the purview of the proposed HIV
Planning Council once established.
6 . Funding to local county health departments should be based on
a planning and evaluation system that considers geographic
region, population, special needs within the county, and HIV
impact within the county.
7 . The HIV Planning Council should examine and pursue other
resources, including city, county, state and philanthropic
dollars, in light of the heavy past and present reliance on
federal funding for HIV/AIDS programs within Arizona.
8. DHS develop an aggressive Technical Assistance program to
assist community groups in procuring grant money.
9. DHS should revise the review process for RFP1s to ensure that
reviewers consider current funding levels, evaluation of past
performance, and incidence of HIV disease in the affected
communities.
10. DHS should make use of a revise and resubmit option for RFP1s
that potentially could impact on HIV interventions.
V. SUMMARY OF PROGRESS REPORTS
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS)
STATUS REPORT
SEPTEMBER 1990
AHCCCS currently provides treatment and all medically necessary
care for enrolled persons with AIDS, ARC, and HIV infection.
Future programs include consideration of expansion of indications
for AZT.
Current resources and funding include: Title XIX, U.S. Social
Security Act, and State appropriations. Future resource needs
include cost increases to expand drug treatment option, and
possible cost increases to expand provider network.
Plans for Inter-Agency Coordination include: consideration of
federal grants for expanded Home and Community Based Services with
the Arizona Department of Health Services, and cooperation with
community agencies.
The Task Force Report contains a number of policy initiatives
pertaining to AHCCCS. Several are reflections of program
initiatives and policies already being addressed by AHCCCS
administration or actually implemented. Others represent
significant changes in program, budget or policy and need more
detailed analysis than can be provided in this brief comment
period. The issues of concern to AHCCCS are listed below, and
accompanied by a short assessment of the impact of the
recommendation and the AHCCCS Administration's current sense of
direction.
EDUCATION MEASURES
ISSUE: EDUCATION FOR 8TATE AGENCY 8TAFF
Case managers and some long term care eligibility staff would need
training. The in-house expertise exists to conduct the training,
so costs would be limited to staff time and materials.
Work-plans have been developed to:
1) Identify employees with direct client contact.
2) Include AIDS education material in orientation packets.
3) Include AIDS education materials in Administration newsletter
twice a year.
ISSUE: CASE MANAGEMENT
Case management is currently provided to most AIDS patients
enrolled with AHCCCS plans. AHCCCS is increasing the emphasis on
case management, and will require documentation that it is being
provided. There are no special requirements for persons who are
HIV positive. It is important for AHCCCS to actively participate
in any group seeking to standardize case management in Arizona.
The budgetary and administrative consequences of some of the
proposal that have come forth are significant. In particular,
efforts by case management agencies to become "sole source
providersff fit poorly with the competitive capitated model of
AHCCCS, and can distort pricing of these services. Standards that
result in excessive services promote dependency and raise costs.
Successful case management has many of the attributes of advocacy,
and increases the intensity of medical services.
Case management has direct and indirect cost implications for
AHCCCS, and presents a coordination problem for participating
prepaid health plans. Any proposal for a statewide case management
program needs careful evaluation.
An AIDS quality assurance program is to be implemented into
contracts beginning October 1, 1990.
ISSUE: HIV/AIDS AND CHEMICAL ADDICTION
Increases in Drug Abuse treatment services are not currently
provided by AHCCCS. There are substantial costs and administrative
effects related to this recommendation.
ISSUE: MENTAL HEALTH
These services are not currently provided by AHCCCS. There are
substantial cost and administrative effects related to this
recommendation.
Currently mental health services for adults are very limited.
Phase-in of services for children is the first priority. Attention
to the needs of AIDS-affected children will be included in the
development of new services.
ISSUE: LONG TERM CARE
AHCCCS Administration has been working on smoothing the transition
from acute care to long term care programs, including improved
information exchange, a better physician network for AIDS care and
expansion of home and community based services. Changes in the 5%
cap on home and community based services have been actively sought,
without success. The use of family attendants as personal care
providers in home and community based services is not actively
being sought, and needs to be examined for its impact on other
issues, such as long term care for Alzheimer's patients and the
increase in applications it might stimulate.
ISSUE: AHCCCB ELIGIBILITY
Expanded eligibility criteria for people with AIDS is a major
policy issue, and affects primarily the state-funded portion of
AHCCCS (MN/MI). AHCCCS is currently examining the potential for
such changes. Among the questions for research are what groups
will be affected, the impact on the size and costs of the AHCCCS
population, whether only AIDS patients should be included or
whether other chronically ill patients should also be included, and
whether HIV infection or AIDS is the desirable screen. State
legislative action would almost certainly be required, along with
waivers from the HCFA.
AHCCCS is awaiting the establishment of a Governor's Task Force on
Long Term Care to study the needs and services for the chronically
ill and physically disabled population.
Work with health plans and program contractors to smooth the
transition between acute and long term care programs is ongoing.
AHCCCS provides nursing home and Home and Community-Based Services
(HCBS). Discussions are ongoing with HCFA on expanding HCBS.
ISSUE: FELLOWSHIP PROGRAM
The availability of well-trained primary care physicians to care
for AIDS patients is of considerable concern to AHCCCS, since
AHCCCS expect to have responsibility for the care of more than half
of all AIDS patients at some time in the course of their illness.
Several physicians who have been caring for a large number of AIDS
patients have full practices at this time. The lead agency for
developing the fellowship program is suggested to be the University
of Arizona medical school, which is appropriate. However, AHCCCS
expects to be actively involved.
Success in attracting primary care physicians to develop the skills
to care for AHCCCS patients with HIV disease may require some
incentives, including the possibility of differential fees or
capitation rates for trained physicians. In addition, policies on
managing the care of AIDS patients, such as channeling them to
trained physicians, may require both policy and contract changes.
No action at present in a joint effort to better train a network
of primary care physicians to care for increasing numbers of HIV
positive persons.
ISSUE: ADVANCES IN TREATMENT
New advances in treatment of HIV/AIDS should be made available
through the University of Arizona. The rules governing AHCCCS
specifically exclude coverage of experimental treatment. To date,
AHCCCS has limited coverage to FDA approved drugs, and has not paid
for experimental drugs and the related costs of participation in
experimental protocols. Changes in this position will have budget
consequences, since discrimination by diagnosis is not allowed.
The increased emphasis on experimental therapies can force changes
in the AHCCCS rule.
FlUANClNG MEASURES
ISSUE: INSURANCE
AHCCCS is interested in insurance risk pooling, mandated insurance
expansions and similar proposals.
ISSUE: COST DATA
AHCCCS would be a primary participant in cost data collection.
Proposals for this data collection will have cost and systems
implications for AHCCCS administration.
ARIZONA DEPARTMENT OF CORRECTIONS (DOC)
STATUS REPORT
SEPTEMBER, 1990
The mission of the Arizona Department of Corrections is to serve
and protect the people of Arizona by imprisoning those offenders
legally committed to the Department. This includes maintaining a
healthy, safe and secure environment for both staff and inmates.
The issue of AIDS continues to be a major concern for the
Department. Policies are in place that address testing, housing,
treatment and confidentiality. DOC has solicited assistance from
other agencies, specifically the Department of Health Services, in
the development of its policies and programs.
All that has been accomplished in DOC in reference to AIDS has been
done without additional resources. Given the current fiscal
situation of the agency, it will be difficult to implement any new
programs without additional resources. DOC encourages the Task
Force to pursue its objectives through the Governor and the
Legislature.
SPECIAL NEEDS
ISSUE: MANDATORY HIV ANTIBODY TESTING FOR NEWLY ADMITTED INMATES
A blinded Seroprevalence survey for HIV antibody testing and
Hepatitis B surface antibody (anti-HBs) was conducted in early 1990
on new male inmates entering the Department of Corrections. Data
was gathered from 1058 volunteers which examined limited risk
behavior information and was correlated with seroprevalence
results. Overall results indicated a 1.5 percent HIV antibody
seroprevalence and 22.5 percent anti-HBs seroprevalence. None of
the behavior risk factors including male to male sexual contact,
needle sharing, or history of blood transfusion were reliable
surrogate workers for HIV infection. Approximately 75 percent of
all inmates volunteering for this study indicated they would
volunteer for anonymous and/or confidential testing.
ISSUE: EDUCATIONAL PROGRAMS FOR INMATES AND STAFF IN CORRECTIONAL
FACILITIES
The Human Resources/development Division of DOC is proposing that
two of the Task Force's recommendations be pursued this year.
Priority #1:
AIDS Training for Staff and Inmates. DOC recommends that a broader
approach be taken that provides training, data collection, and
treatment protocols for communicable diseases, not just AIDS, and
that security staff be immunized against Hepatitis B, mumps,
measles, and Rubella (MMR). The cost is $427,400.
In an effort to address these major issues, DOC is issuing a
Request For Proposal for professional services. This request
includes educational programs for staff and inmates; clinical care
of inmates identified as HIV+, ARC, and AIDS; gathering of
statistical data; and, establishing treatment guidelines which
include post-release continuity of care utilizing community
resources.
ISSUE: HIV/AIDS MEDICAL CARE AND TREATMENT IN THE CORRECTIONAL
GETTING
Priority #2:
HIV/AIDS medication. Over the next three years, it is anticipated
that the detected number of HIV positive and AIDS infected inmates
will increase from 39 to 300. DOC concurs with the Task Force
recommendations that AZT treatment be provided to all known
infected inmates. The cost pattern is as follows:
ANNUAL INCREASE CUMULATIVE INCREASE
FY 1991 (1st Year) $146,600 $146,600
FY 1992 (2nd Year) $241,700 $388,300
FY 1993 (3rd Year) $241,700 $630,000
DOC is continuing to provide necessary medical care and counseling
to those inmates identified as HIV positive, ARC or AIDS. The
treatment protocol for AZT has been updated to reflect changes
recommended by the Center for Disease Control (CDC).
DOC is continuing its efforts to address the issue of AIDS in the
prison setting. Through an outside contractor, the issues of needs
assessment, short and long term health programs, inmate and staff
education, prevention and post release follow-up will be studied.
This information, along with the results of the blinded
seroprevalence study will assist in the Department's formulation
of revised policies and procedures. Policy and Procedure is being
developed to address the issues of consent to test and treat,
confidentiality and disclosure of information. This is to ensure
compliance with the recently enacted ARS 36-663, 664,667.
ISSUE: PREVENTIVE ISSUE8 IN CORRECTIONAL FACILITIES
DOC is not considering the issuing of condoms in the prison
setting. The supplying of condoms remains a security issue and
could be viewed as condoning acts that are in violation of DOC
rules and regulations, and law. The Department has followed the
recognized premise that the best prevention is good education.
STATUS REPORT
SEPTEMBER 1990
The passage of HB 2173 together with the provisions of ARS 920-448
provide statutory authority to the Insurance Department to
promulgate its previous guidelines as rules. The Department of
Insurance is in the process of drafting rules to implement
allowable tests and testing procedures, written consent to perform
HIV related test procedures for confidentiality and disclosure of
medical information, procedures for gathering underwriting
information, and other rules that are reasonable and necessary to
implement A.R.S. 920-448.01 as enacted by HB 2173. These rules
will consist of the Department's current "AIDS Guidelines.@'
Because the rule-making procedure is quite lengthy the adoption of
rules will not occur prior to September 27th, effective date of HB
2173. Therefore the department has prepared a model consent form
for HIV testing. Until adoption of the rules, insurers may choose
to use the model consent form or may submit the forms they
currently use for approval by the Department of Insurance. The
following areas summarize the Department's response to critical
areas outlined by the Task Force.
Areas Where Inquiry Would be Prohibited and Sexual orientation:
The Department has adopted l1AIDS Guidelinesl1 which prohibit
insurers from inquiring into the applicant's sexual orientation,
the applicant's receipt of blood transfusions or applicant's
previous HIV tests, except that the insurer may ask whether the
applicant has ever been diagnosed or treated for HIV disease, or
has tested positive for HIV antibody.
Uniform Application of HIV Tests; Uniform Testing Based on Type,
mount of Policy, and Testing in Conjunction with other Medical
Procedures: Guidelines permit an insurer to test for HIV
antibodies as it tests for other conditions affecting mortality and
morbidity. Tests cannot be performed without written consent of
the applicant.
Informed, Written Consent and Prescribed Testing Protocol: AIDS
Guidelines prohibit the use of test results as a basis for an
adverse underwriting decision unless the insurer has verified that
both a positive screening test (such as ELISA) and a positive
supplemental test (such as Western Blot) result have been
determined. Tests must be FDA-approved. A standard consent form
has been drafted by the Department.
Periodic Review of State Testing Technology to Revise Protocol:
Department of Insurance will promulgate regulation and will
coordinate with Department of Health Services to gather necessary
information and advise regarding appropriate test protocols.
Counseling (Pre-and Post-Test):
Rules will require discrimination of information regarding the
availability of free confidential counseling along with a time
frame for the person to seek such counseling.
Confidentiality:
House Bill 2173 authorizes Department of Insurance's rule-making
authority regarding confidentiality of HIV testing.
Exclusion of Certain Types of Conditions: Guidelines do not permit
insurers to issue for delivery in Arizona any contract which
excludes AIDS or ARC from coverage. Benefits for AIDS and ARC
shall be provided for in the same manner as are provided for all
other catastrophic disease.
Classification of Treatments: Policies which include benefits for
prescription drugs shall provide benefits for AZT as well as any
and all other FDA approved drugs and forms of treatment.
Risk Pooling: Department of Insurance is examining other states'
risk pools in conjunction with the Joint Legislative Committee on
Health Care.
Change in ERISA: Department of Insurance has been and continues
to work in conjunction with the National Association of Insurance
Commissioners (NAIC) to inform Congress of changes we believe are
required.
Reimbursement of Drug Treatment: Guidelines require that where
policies provide benefits for treatment and drugs, benefits must
include AZT as well as any other drug approved by the FDA.
ARIZONA DEPARTMENT OF ECONOMIC SECURITY (DES)
STAWS REPORT
SEPTEMBER, 1990
The DES provides opportunities, services and programs through an
integrated delivery system to Arizonans with economic or social
difficulties which will enable them to maintain or move toward
self-sufficiency. The recommendations of the Task Force are very
broad and will require the cooperation of many agencies within
state government. DES is supportive of a cooperative effort to
lessen the threat of this epidemic in Arizona. The recommendations
which are implemented have been accomplished within current DES
resources. Funding includes Children's Services, Day Care and
training dollars. The number of children with HIV currently cared
for by the department is minimal. As the number of children in
care increases, special budgetary needs will become a factor.
Immediate funding is necessary to carry out department wide AIDS
training. The Task Force clarified and brought to immediate
attention AIDS issues that needed to be addressed by DES.
ISSUES: CHILDREN UFECTED BY HIVIAIDS
Testing children for HIV: The recommendation is implemented.
The current Administration for Children, Youth and Families (ACYP)
AIDS Policy supports careful testing of foster children with
cautious interpretation of test results, Guidelines for case by
case assessment of testing needs are found in the Testing, section
H. of the ACYF AIDS policy. The issue of confidentiality, and
disclosure of information on a need to know basis is also a part
of the current AIDS policy.
Recruitment and AIDS education of foster families: The
recommendation is implemented. At this time recruitment of foster
families for HIV/AIDS affected children is done on an as needed
basis because the need has not demanded an aggressive campaign.
ACYF has a copy of the Child Welfare League of America (CWLA)
recruitment video which focuses on families to care for this
population. This can be shared statewide when needed. In
addition, the ACYF Statewide Recruitment and Retention Task Force
can be utilized to organize aggressive recruitment strategies when
needed. Recruitment and licensing for this population requires
involvement of local medical resources to adequately train
potential care-givers. Both the Phoenix and Tucson areas are
already using some of these resources for the limited number of
children in the department's care.
Foster care incentives: The recommendation is implemented.
The ACYF AIDS Policy allows for incentives for foster parents to
care for children infected with HIV. At this time reimbursement
for care is done on a contracted basis allowing for the individual
needs of a particular child. The foster care rate schedule is
utilized as the basis in developing the contractual agreement.
Relative caretakers can be licensed foster parents and receive the
same benefits.
Free or subsidized day care: The recommendation is implemented.
Day care services include care provided in licensed day care
centers and certified day care homes on a regular basis for
compensation and lasting for periods of less than 24 hours a day.
Day care subsidy is available to eligible clients with HIV infected
children. Clients are advised of available homes and center
placement options. Any facility knowingly accepting an HIV
infected child shall be fully trained in the care and supervision
of such children and adequately staffed to handle these needs.
Appropriate transitional facilities: The implementation will be
considered if the need arises. Because of the minimal numbers of
HIV/AIDS affected children in the department's care in Arizona at
this time, there has not been a need for such a service. ACYF is
not entirely supportive of group care programs forthis population.
As this need arises, the department would prefer contracting for
a service which could be delivered in the child's family home or
foster home. A request for Proposals (RFP) could be developed in
preparation for in-home services which may also benefit the drug
affected/addicted baby population.
EDUCATION MEASURES
ISSUES: EDUCATION FOR STATE AGENCY GTAFF
Staff education for day care centers: The recommendation is being
implemented. DES will give specialized training to DES and
contract agency staff, licensed foster families, certified adoptive
families and day care providers who provide direct physical care
to children and adolescents with known HIV infection. Respite
services are available through the assigned case manager. In-depth
training has been implemented for ACYF and DDD staff. Department-wide
training will be implemented in FY 1991.
The DES Office of Human Resources (OHR) will coordinate AIDS
training for the department. It will:
* Identify qualified community professional or health services
organizations which are willing to provide training for DES
on a volunteer basis.
* Develop the training schedule, promote the training, enroll
participants, and assemble resources;
* Evaluate the training content and presentation to ensure
highest quality.
ISSUE: EDUCATION FOR HEALTH CARE INSTITUTIONS
HIVIAIDS Education in Health Care Institutions: The recommendation
is implemented. The Division of Developmental Disabilities (DDD)
has developed and implemented a training module on HIV/AIDS for the
Intermediate Care Facility/Mentally Retarded staff which is
included in the required basic training.
SUPPORT AND TREATMENT MEASURES
ISSUES: CASE GEMENT
DES would appreciate the opportunity to provide a representative
in the development of a Task Force as recommended to address the
issues that relate to case management and client services. There
is no additional cost associated with this recommendation at this
time .
ISSUE: LONG TERM CARE
Long-Term care options: The recommendation is implemented.
All recommendations concerning both the short and long-term care
of an HIV infected child accepted by the DES system are made by the
child's appointed service team including the physician, DES case
management, unit supervisor, child's guardian ad litem/CASA,
potential providers/caretakers and/or adoptive parents. This
service team continually monitors the placement of the child and
adjusts according to the child's condition. Medical care is
provided through the DES comprehensive Medical and Dental Program
(CMDP) .
ARIZONA DEPARTMENT OF EDUCATION (DOE)
STATUS FIEPORT
SEPTEMBER, 1990
Objectives for the 1990-1991 Budget Period:
1) The budget will remain the same as last year $215,616.
Department of Education has additional carry over funds which
will make it possible for the Department to set up two
regional training centers to better assist rural communities
in their HIV Education and prevention efforts.
2) The Centers for Disease Control specifies that the Department
demonstrate increases in:
* the number of junior and senior high school students who
receive HIV education; and
* the number of junior and senior high school students who
receive HIV education within a Comprehensive Health
Education Program.
To demonstrate these increases we are required to conduct two
annual surveys :
* The HIV Educational and Policy Development Survey which
is sent to over 1000 schools throughout the state, and
rk The Youth Risk Behavior Survey (YRBS) which is to be sent
to approximately 50 schools, involving 2500 students at
grades 9-12. This survey asks questions about individual
involvement in several high risk behaviors including drug
use, sexual activity and suicidal thoughts or attempts.
Both surveys are voluntary and will be encouraging full
participation. 1990 will be the first attempt with the YRBS but
it has been approved by the DOE Program Review Committee and has
been endorsed by the National PTA, National School Board
Association and National State Boards of Education. Department of
Education is hoping such support will further encourage school
districts to participate.
To accomplish the above objectives a number of activities have been
planned including a continuation of one and two day regional
training programs at no cost to the school districts; regional
updates for educators and administrators who have already attended
a two day intensive; regional parent education programs, and
programs specifically designed for local school boards and school
administrators.
The Governor's Task Force On AIDS recommendations are in complete
agreement with the stated objectives of DOE. In light of
diminishing resources specifically for HIV education in schools,
the Department is exploring the potential of including HIV
information and prevention strategies into several of the Substance
Abuse Prevention Programs currently operating in many of the school
districts. Student Leadership and Peer Education models have also
begun to bear fruit. The Flagstaff Unified School District for
instance has recently received a $7000.00 award from the
Metropolitan Life Insurance Company for their "Healthy Mett Program
including $2000.00 for the HIV Education Component. Several
Arizona schools have received national recognition from the United
States Department of Education (USDOE) for the their excellent
substance abuse prevention programs. Most of these programs
already include skill-building in areas such as refusal skills,
coping with peer pressure and self-esteem enhancement projects.
The USDOE also requires an annual drug use survey in conjunction
with Drug Free schools funding which is conducted at both the
elementary and secondary level by the Arizona Criminal Justice
Commission.
EDUCATION MEASURES
ISSUE: SCHOOL-BASED EDUCATION
By the beginning of the 1989 budget period, a HIV Education
specialist had been employed at the Arizona Department of Education
for six months. After reviewing the results of the first AIDS/HIV
Education and Policy Development Survey, which included a brief
needs assessment, (see attached 1989 report), it was determined
that the first priority would be to conduct eleven, two-day
regional training programs which would include information on
policy development, age specific curriculum suggestions, an
extensive 'IAIDS 101" program and, whenever possible, presentations
by persons living with HIV disease. It should be noted that 77%
of all districts responded to the survey, despite the fact that
HIV Education is not mandated. This response far exceeded
projections.
The goal of the training program was three-fold:
* to reduce the fears surrounding HIV infection and increase the
comfort level among school personnel about having a child or
adult with HIV in the school setting,
* to let districts know that there was a person on staff at DOE
who was available to assist them in their HIV education and
policy development efforts and,
* to build a statewide coalition of support for the concept of
providing HIV instruction within the context of a
comprehensive school health curriculum. The evaluations of
the programs were very encouraging, and further evaluation
will be accomplished when the results of the 1990 HIV
Education and Policy Development Survey are compiled. DOE has
hired a consultant to analyze the survey data and prepare a
full data report; The DOE Education Specialist has reached
approximately 40% of Arizona school districts with free, HIV
educational programs. While not every district has named an
HIV Education Coordinator, the person often identified is a
school nurse. Several individuals working in the HIV
education field are now assisting schools in their perspective
counties both as volunteers and paid consultants. Seven
excellent HIV educators report they have assisted over 300
schools reaching approximately 13,000 students and 880 school
personnel. These individuals have attended one of DOE'S two
day regional workshops and additional training from DHS.
These individuals and DOE staff meet on an ongoing basis to
provide mutual support, share ideas and problem solve.
Since there has not been an opportunity to analyze DOE survey data,
it cannot be determined whether there has been an increase in the
number of Junior and/or Senior high schools, which offer HIV
education. Department of Education is certainly anticipating a
small increase. The familiar problem is that health instruction
is not required beyond the eighth grade in Arizona, so teachers do
not have a context in which to teach the subject. DOE is
attempting to rectify this situation in five ways:
1) DOE has supported H.B. 2361, which would require instruction
on Acquired Immune-deficiency Syndrome (AIDS) and the Human
Immune-deficiency Virus (HIV) in grades K-12.
2) The Comprehensive Health Essential Skills for grades K-12 have
been approved by the Arizona State Board of Education. The
approval by the Board does not mandate comprehensive health
in either kindergarten or grades 9-12, however it does lay a
foundation for an intensive training effort to encourage
participation, especially, in the upper grades.
3) Training programs offered during the Fall 1990 and Spring 1991
school year will have either an elementary or a secondary
focus, thus allowing more time for age specific instruction
and practice. Training capacity will be expanded with the
use of regional training consultants and will include more
information on minority issues, which hopefully will attract
more high school teachers and/or administrators in our inner
city schools.
4) DOE arranged to play a greater role in school team training
this year. School teams from throughout the state come
together for four days and nights to develop substance abuse
prevention plans for their school or district. This year DOE
will be encouraging teams to incorporate HIV information and
prevention strategies into their plans. Since many of these
schools do not have comprehensive health education, chemical
abuse prevention programs are a logical resource.
5) The Comprehensive Health Unit's HIV Program sends a
newsletter, every other month, to all public school district
superintendents, BIA school administrators, all school nurse
supervisors (over 200 statewide), all former participants in
regional training programs and all county health departments
and community service agencies serving youth at risk. The
newsletter serves as a resource regarding upcoming events,
news briefs, accolades for model HIV education programs, and
in Fall, by request, a Question & Answer column. By providing
support to schools who have not yet participated in trainings,
DOE is hoping to motivate them to participate in the next
series of workshops.
ISSUE: EDUCATION FOR STATE AGENCY STAFF
The Task Force also addressed the issue of HIV Education for DOE
staff. An educational program on HIV was presented to management
in June of 1989 and three consecutive employee programs were
provided during the month of July 1989. The HIV Education
Specialist conducted the program with the assistance DHS staff.
The response was very positive. The HIV Specialists are planning
an employees Update during the 1990-91 grant period.
SPECIAL NEEDS
ISSUE: YOUTH AND HIV/AIDS
On April 19-20, 1990, the Department sponsored a conference
entitled, l1What Works! HIV 1nt.ervention Strategies For Out-of-
School Youthv1. Twelve agencies assisted in the planning and
implementation of the event, which drew over 125 people each day,
including presenters. Sixty-four agencies were represented, which
is 32% of the 200 youth serving agencies registered in Arizona.
This was a good beginning and a meeting has been scheduled to
evaluate our efforts and begin planning for our 1990-91 conference.
The CDC has also made it possible for the Department to take school
personnel, staff from agencies serving out-of-school youth and
county health departments personnel to regional training centers
for a 3-5 day intensive HIV education program. Representatives
from Tucson Unified School District, Phoenix Union High School
District, Urban League, Matrix Incorporated, Our Town Family
Centers, Tumbleweed, Glendale Youth Centers, Arizona Department of
Corrections and the Maricopa County Homeless Outreach Program have
attended such programs.
To achieve the objective pertaining to HIV education for
developmentally-delayed students, the Department invited a
consultant who had experience with HIV education to this population
to present a half-day workshop at the DOE annual Special Education
Conference on March 2, 1990. Unfortunately, attendance was light
(25 people) for this concurrent session, so a committee on HIV
education for special populations has been formed to develop
strategies for reaching a larger Education Programs. The new HIV
education specialist has certification in Special Education and is
very interested in chairing this new committee.
The Youth Risk Behavior Survey was not completed this year. The
HIV Education Specialist hired to take the lead on this project
resigned due to health related problems. Unfortunately, it took
several months to hire a replacement and the remaining HIV
specialist was already committed to numerous training projects.
Upon evaluation it was determined conducting a student survey late
in the year would be detrimental to the relationship between DOE
and local school districts. The Drug Use Survey in Arizona
Schools, conducted by the Arizona Criminal Justice Commission in
cooperation with the DOE and USDOE, (United States Department of
Education), has also recently been conducted in the schools.
Fourteen of the questions in this survey are also included in the
Youth Risk Behavior Survey.
The Centers for Disease Control also requires that the Department
assist agencies serving youth who are not attending traditional
school programs. The Department plans to conduct an annual
conference specifically designed to assist agencies serving youth
at special risk for HIV infection and will also keep these agencies
updated with information through the departments HIV newsletter.
A committee of representatives from CBO1s serving youth at risk
will be assisting the Department in planning efforts.
STATUS REPORT
SEPTEMBER, 1990
The Arizona Department of Health Services involvement in the public
health challenge posed by AIDS began in 1982 when the Centers for
Disease Control (CDC) requested that all states determine
retrospectively if AIDS cases had occurred and at that time DHS
established prospective AIDS surveillance systems.
Since that time, DHS AIDS program, located within the Division of
Disease Prevention, has grown from a zero budget and no positions
to annual funding of over $3.0 million (approximately $450,000
state, $2.7 million federal) and 22 staff (5 state funded, 17
federally funded). Of the funding received, approximately $1.6
million directly supports local health departments and community
organizations in their efforts against HIV infection and AIDS. In
addition, more than $200,000 is currently being utilized to
purchase Zidovudine for distribution through DHSws AIDS therapy
distribution program.
In July, 1990 the DHS AIDS Education staff merged with the HIV
Program Section staff to create the Office of HIV/AIDS Services.
Previously, the AIDS Health Education staff was part of the Office
of the Office of Health Promotion and Education, and the HIV
Program Section staff was part of the Office of Infectious Disease
Service. Because the staffing, funding and programming mix of DHS
HIV/AIDS activities have grown so significantly over the last four
years, it was determined that an office on AIDS should Itstand
alonew1 rather than as part of two separate offices. Additionally,
HIV/AIDS issues represent a significant public health priority in
Arizona, warranting a coordinated focal point, visibility and
accountability. The HIV/AIDS Epidemiology Section, is responsible
for AIDS case reports, Family of Surveys and other specialized
epidemiologic studies. Because this is primarily an internal
organizational change, staffing and program and activities will
remain virtually unchanged.
AIDS-related activities involve every division of the Department.
Current programs cover a broad base of areas of HIV/AIDS, including
surveillance activities, seroprevalence studies, counseling and
testing programs, minority education initiatives, public
information programs, and programs directed at intravenous drug
users and gay/bisexual men. In addition, the Department continues
to work closely with a wide variety of community agencies and with
other State agencies. Details of these programs and coordination
activities is included in the Task Force Report of November, 1989.
ISSUE: CONFIDENTIALITY OF HIV INFORMATION
HB 2173 contained agency sponsored sections that provide for
enhanced protection of communicable disease information as
recommended by the Governorls Task Force.
ISSUE: DUTY TO WARN OR PROTECT
This section of HB 2173 authorizes physicians to notify sexual and
needle-sharing partners of infected individuals and health care
workers exposed to infected individuals. DHS contracts with nine
county health departments and require that counties assure that
partner notification takes place and, as necessary or requested,
perform partner notification services.
ISSUE: TESTING AND COUNSELING
DHS does not believe that a formal certification process for
anonymous testing beyond county sites is either practical or in the
best interest of public health. A certification process would be
required and additional resources needed. Currently, DHS has
adopted a permanent rule to replace the 18-month emergency rule
A.A.C. R9-6-701 that would continue to require all county health
departments to offer an anonymous testing option. In certain
instances, under county supervision, anonymous counseling and
testing is being offered at non-county sites.
ISSUE: POST-TEST COUNSELING
DHS has requested additional funding for HIV counseling without
success from the State Legislature for the past several years. In
addition, the DHS continues to seek additional funding from CDC for
HIV counseling and testing activities.
EDUCATION MEASURES
ISSUE: HIV/AIDS EDUCATION FOR ALL ARIZONA CITIZENS
With respect to general media campaigns, the DHS serves as state
liaison for CDC national media campaign, ItAmerica Responds to AIDSt1
which is directed toward reaching all Arizona citizens. DHS
orchestrates a month-long awareness campaign during October, which
is recognized as national AIDS Awareness month. DHS publishes a
quarterly statewide newsletter on HIV/AIDS. This publication is
distributed to over 13,500 people throughout Arizona.
ISSUE: SCHOOL-BASED EDUCATION
DHS co-developed the existing guidelines for curriculum development
and continues to work cooperatively with the Department of
Education. DHS funds, through CDC monies, health educators in
several local health departments who in turn provide HIV education
programs in schools.
ISSUE: EDUCATION FOR HEALTH CARE PROFESSIONALS AND
PARAPROFESSIONALS
A clinical public health guide for physicians is being developed.
This guide will include information for physicians on HIV
counseling and testing, reporting requirements, evaluation and
treatment issues, as well as resources for referrals. DHS staff
serve on the Advisory Committee for the federally funded
professional education programs at the University of Arizona and
Maricopa County Area Health Education Center grant. In addition,
DHS works closely on a continuing basis with the Arizona Medical
Association, the Arizona Osteopathic Medical Association, and the
Arizona Hospital Association on professional education issues and
programs.
ISSUE: HIV/AIDS EDUCATION FOR STATE AGENCY STAFF
DMS is currently exploring methods of including information on
HIV/AIDS in new employee orientation. DHS has consulted with other
state agencies including the Departments of Transportation, Public
Safety and Economic Security to assist them in developing HIV/AIDS
workplace education programs. DHS has provided training in the
past for all DHS employees on a voluntary basis.
ISSUE: OUTREACH
Currently, outreach models are used in the following funded
programs: Tucson AIDS Project, for persons who are gay and IV drug
abusers, high risk adolescents and IV drug abusers; Southminister
Social Services to reach the Black and Hispanic community in South
Phoenix; CODAMA for IV drug abusers in Maricopa County; Indian
Community Health Service, Inc. to reach Native American men and
women at increased risk. Subcontractors through Maricopa and Pima
County Health Departments utilize a variety of outreach methods
including contacts at bars and events in the gay community. DHS
will be requesting additional state funds to support further
outreach activities in its upcoming budget request.
ISSUE: MINORITY ISSUES
DHS currently provides $157,000 in federal funds for AIDS education
in minority communities. In addition, DHS will be requesting
additional funds to augment current efforts. DHS is also providing
technical assistance through the use of national minority
consultants who will conduct evaluations of existing programs.
Minority contracts are written for two year periods and will
continue to be supported for two years to allow Contractors
adequate time to plan, implement and evaluate their HIV education
programs. With regard to a comprehensive epidemiologic study of
HIV/AIDS among minorities, current DHS seroprevalence studies and
surveillance data do not demonstrate the need for special study.
ISSUE: YOUTH AND HIV/AIDB
DHS intends to continue to work collaboratively with DOE and to
allocate staff time to identify potential sources of funds for high
risk youth. DHS has funded two projects who have developed peer
group leaders for the Hispanic population and high risk minority
teens. In Pima County, the Tucson AIDS Project provides regular
AIDS education sessions for incarcerated youth, A liaison has been
established with the Training Coordinator for the Arizona
Department of Corrections (DOC) and the Regional Health
Administrator at Adobe Mountain. DHS will develop additional
training programs in coordination with the DOC staff.
ISSUE: WOMEN AND HIV/AIDS
DHS has completed a statewide survey to assess the current status
of HIV education provided in public prenatal clinics and family
planning clinics. On the basis of the survey results, DHS will
develop a strategy to encourage women's clinics to provide HIV
education as part of routine services. DHS will be requesting
supplemental CDC funds to purchase brochures specifically directed
toward women. All DHS funded family planning contracts have a
provision requiring contractors to provide HIV education and
referral for counseling and testing when appropriate. The State
Laboratory provides HIV testing services for several community
based clinics that primarily serve women in several areas of
Arizona, including Planned Parenthood Clinics,
ISSUE: GAY AND BISEXUAL MEN
Focus groups to supplement the formal KAB and to provide future
direction to the prevention activities including a proposed media
campaign have been organized. Focus groups, in combination with
the formal working in the community, will provide the data needed
to direct the prevention effort in the 1990's. A community
planning committee should be organized by the gay community in
cooperation with, not by DHS. Additional funds are needed to
support the educational efforts in the gay/bisexual community
including gay/bisexual men in the minority community. DHS issued
a request for proposal for this target population, and one contract
exists with Indian Community Health Service, Inc. for high risk men
and women. In order to adequately support AIDS prevention
activities in the gay/bisexual community, the DHS is requesting
additional state funding through an upcoming budget request.
ISSUE: PREVENTIVE ISSUES IN CORRECTIONAL FACILITIES
This recommendation represents a policy decision on the part of
the DOC. DHS is willing to provide technical assistance as
necessary in developing appropriate policy.
ISSUE: DECONTAMINATION OF EMERGENCY TRANSPORT UNITS
DHS Division of Emergency Medical Services will incorporate
procedures for decontaminating vehicle non-disposable equipment
into its proposed statewide "Minimum Standards for Non-physician
Pre-hospital Treatment and Triage of Patients Requiring Emergency
Medical Services1@. In addition, the Division of Emergency Medical
Services will require certified emergency medical service providers
to maintain written policies and procedures for the decontamination
of patient transportation vehicles.
ISSUE: RURAL AREAS
An assessment of current funding levels from DHS to rural health
departments has been conducted. Listed below are 1990 aggregate
funding levels for rural and urban counties with DHS contracts for
HIV health education/risk reduction and HIV counseling and testing.
Rural counties include Cochise, Coconino, La Paz, Pinal, Santa
Cruz, Yavapai and Yuma. Urban counties include Maricopa and Pima.
Total 1990 funding ~unding per Funding per
from ADHS capita AIDS case
Rural $253,874
Urban $484,487
DHS has consistently sought additional funding both from CDC and
from the State of Arizona to augment current AIDS education funding
levels for local health departments. Annually, DHS holds a
statewide meeting of all county health department AIDS personnel
in the Spring and an HIV Health Education Conference in the Fall.
ISSUE: BIV/AIDS AND CHEMICAL ADDICTION
DHS Division of Behavioral Health Services is continuing to provide
funding for substance abuse programs through the administrative
entity system. Recent increases in federal funding specifically
for treatment of intravenous drug use has increased the number of
available treatment slots. At this time, there are no plans to
develop a special incentive program for out-of-treatment IV drug
users to seek treatment. Instead, DHS Divisions of Behavioral
Health Services and Disease Prevention will continue to work with
community agencies to strengthen outreach programs designed to
encourage persons both to seek treatment for substance abuse and
to reduce risk of HIV infection. The need for a special
feasibility study concerning needle and syringe exchange programs
is being explored. The Division of Behavioral Health Services is
currently working with the Department of Economic Security and the
Arizona Health Care Cost Containment System (AHCCCS) to implement
a comprehensive program for drug using women. The Division of
Behavioral Health Services is continuing to gather data on drug
abuse in Arizona. Comprehensive data reports will be produced at
the end of the fiscal year.
ISSUE: MENTAL HEALTH
The DHS Division of Behavioral Health Services is exploring the
necessity and practicality of developing a task force specifically
to address the issues relating to the mental health of HIV/AIDS
patients.
ISSUE: FELLOWSHIP PROGRAM
As appropriate, DHS AIDS Program staff will continue to provide
consultation in the development of this program.
ISSUE: COST DATA
The Office of AIDS will continue to cooperate with AHCCCS and the
DHS Office of Health Economics and Facilities Review in further
refining methods to determine trends in health care costs due to
HIV-related illness.
ARIZONA DEPARTMENT OF PUBLIC SAFETY (DPS)
STATUS REPORT
SEPTEMBER, 1990
As AIDS developed into a national health problem, issues
surrounding this disease became a vital topic of concern to all
members of the law enforcement community. It is well established
that law enforcement personnel, paramedics, hospital workers and
others are in daily contact with persons or biological specimens
suspected of containing the AIDS virus.
A review of the Governor's Task Force Report on AIDS reveals
several issues that will have an impact on the Department of Public
Safety and law enforcement agencies in general.
P NTlON MEASURES
ISSUE: CONFIDENTIALITY OF HIV INFORMATION
This entails several areas of concern regarding disclosure of HIV
related information, civil/criminal penalties and types of
information requested.
RIGHTS PROTECTION MEASURES
ISSUE: VICTIM'S RIGHTS
Advocacy groups have shown strong support for victims of violent
crimes in which significant exposure to bodily fluids has been
documented. These same groups support legislation giving crime
victims access to HIV related information to criminal offenders.
OTHER ISSUES OF CONCERN TO LAW ENFORCEMENT
Corrections (educational testing, treatment, prevention and inter-departmental/
law enforcement communications).
Discrimination
Transport Units and Crime/Accident Scene Decontaminations
HB. 2173 AIDS OMNIBUS BILL
The Department legal staff is reviewing this legislation which
became law on June 1990.
SUMMARY OF COUNlY HEALTH DEPARTMENTS
CURRENT STATUS
COCHISE
Provides HIV testing and counseling, community outreach, local
resource for AIDS information; develops and implements community
prevention programs; train Public Health Nurses to test and council
for HIV; is expanding programs for Hispanics and IVDUvs; is
implementing teenage/peer advocacy program in high schools; needs
community outreach workers trained in reaching IV drug users, also
need assistance in training local counselors on how to counsel
persons about HIV.
COCONINO
Provides HIV testing and counseling. Currently involved in HIV
education within the community and with health care professionals.
Have networked with the Native American community in the county to
address HIV education as well as other public health issues.
Provide HIV educational materials and seminars within the county
area. Have actively participated in coalitions and networked with
others both in the county and the state to address HIV issues.
GRAHAM COUNTY
Provides anonymous testing with pre and post-test counseling by
appointment only; distributes HIV educational literature to Family
Planning Program clients and to any client diagnosed with an STD;
counseling is given to all STD clients on a one-to-one-basis; all
HIV related efforts are funded by the County; application for a
contract with DHS will be made when the demand for this service
arises. At present the demand for more resources is low.
GREENLEE
Provides anonymous testing and counseling is offered; offers
preventive education to school and community based organizations;
identifies clients at risk by using "AIDS High Risk Questionnairett;
no money from DHS for HIV/AIDS programs; county dollars support
staff in providing services and materials.
MARICOPA
Provides risk reduction education to general community through
Speaker Bureau and programs targeted at Minority women, and gay
community. (through contracts with community based organizations).
HIV testing and counseling is available at STD clinic and Homeless
site; AIDS surveillance (case investigation, contact tracing with
consent, statistical compilation); case management through HRSA
grant (through 9/30/90) ; integrated Primary Health Care and IV drug
rehabilitation to users and their families to reduce spread of HIV.
Current funding through DHS from CDC to Marico~a County includes:
$ 95,538/year for surveillance
(80,000 state; 15,538 federal)
$ 95,00O/year for family of surveys
$105,494/year for health education
$157,00O/year for HIV counseling and testing
Federal funding from:
$ 407,70l/FY 1990 HRSA
(Health Resource Services Administration)
$ 375,00O/FY 1990 BCHDA
(Bureau of Health Care Delivery & Assistance)
County Funding:
$ 20,000 for volunteer coordination subcontracted to
Phoenix Shanti Group.
Additional funding is needed for health education/risk reduction
in gay/bisexual community, minority communities, for sexually
active adolescents, and for women at risk. Additional resources
are needed to increase ability to do contact notification and
tracing
NAVAJO
Provides pre and post test HIV counseling and anonymous partner
notification counseling with family and friends as needed.
Appropriate referrals for individuals impacted by HIV; community
education via Public Health Nurses panel and videos is provided.
PIMA
Provides HIV counseling and testing; genera1 and targeted HIV
education and preventive services and education to provided
targeted intervention with IVDUs and their sexual partners.
Developed a risk reduction project for gay/bisexual men; Conducts
media campaigns; performs disease investigation, surveillance and
confidential partner notification; networks and collaborates in
Pima County and around the state; working with and developing HIV
education programs in ethnic minority communities.
The following is a list of resources from which Pima County
receives funding. Included below are the sources of funds, the
amountstand specific areas targeted by the funds:
Source
PCHD
ADHS
Annual Amount Area/Servises
Funded
Program Administration
Advertising/Media
Campaigns.
$ 52,595 Surveillance, Case
Investigations, and
Partner Notification
Assistance.
ADHS/CDC $104,003 HIV Health Education/
Prevention/Risk
Reduction.
ADHS/CDC $117,388 HIV Counseling and
Testing Services.
NIDA
HRSA
In&ewention/Outreach/
Research with IVDU1s
and Sexual Partners.
$135,000 HIV Services Planning
Psoj ect .
PINAL
Provides anonymous or confidential pre and post test counseling and
testing, performs surveillance activities; coordinates a speakers
bureau to address community educational needs. Resources needed
include HIV knowledgeable primary care providers, increased
community education for both low risk and at risk populations,
increased resources for providers, and increased funding for both
direct care resources and prevention activities.
YAVAPAI
Provides HIV counseling and testing. Cooperated with Veterans
Administration Hospital and with Yavapai Guidance Center regarding
the coordination of HIV support groups. Need additional funding
to expand services.
YUMA
Provides HIV counseling and testing; conducts case investigation,
confidential partner notification and community education. Need
additional resources to provide programs and support for people
with HIV.
FUTURE PLANS
COCHISE
Developing local support groups to assist persons living with HIV
disease with services, support and resources; establishing a social
services committee for programs for to assist with education and
prevention programs.
COCONINO
Continue to address HIV education and prevention with high risk
populations. Attempting to seek funding for HIV prevention
efforts. Continue to offer HIV testing and counseling. Continue
to work with community based groups to address HIV issues.
GRAHAM
DHS HIV public relations staff send informative and educational
articles for publication in local newspaper. Until the numbers
require more than the inter-agency coordination with Cochise County
health educator, no plans to expand our current offerings.
GREENLEE
Plans to provide HIV education to staff on an annual basis.
MARICOPA
Plans to develor, an HIV Clinic to provide health care to both
asymptomatic ani symptomatic indivi~uals, including dental and
psychiatric services. Services to be coordinated with CBO's
providing case management.
NAVAJO
Plans to continue coordinating with other organizations.
PIMA
Planning in collaboration with other groups in Pima County to
develop, a screening clinic where asymptomatic HIV infected persons
can monitor their health. The services of such a clinic would
include physical examinations with immune system monitoring,
psychosocial support services, behavioral counseling and support,
and referrals to other resources in the community. Planning for
the expansion of existing services, particularly HIV Counseling and
Testing, to better address the needs of our clients. Other special
projects/interventions with high risk populations or segments of
our community are anticipated.
PINAL
Developing a speaker bureau to offer educational services to
interested agencies. Coordinating Arizona AIDS Education Breakfast
Meeting to provide for interagency networking.
YAVAPAI
Developing a community coalition.
VI. PRIORITY LIST OF OVERSIGHT COMMITIEE
RECOMMENDATIONS
MINORITIES AND HIVIAIDS
CURRENT STATUS
STATE AGENCIES
DEPARTMENT OF HEALTH SERVICES
Funds four community outreach programs in minority communities.
The 1990-91 funding for AIDS education and training programs from
CDC totaled approximately $157,000 awarded to: Central Navajo AIDS
Coalition; Indian Community Health Services; Pascua Yaqui Tribal
Health Department; and Southminster Social Service. Minority
contracts are now written and supported for 2 year periods,
allowing time for planning, implementing, and evaluating education
programs. Since 1987, the Department has requested additional AIDS
education funding for persons at increased risk for HIV, including
minority groups. However, to date, no additional funding has been
provided for this purpose. The Office of the Director has
initiated an DHS Working Group to review health data on ethnic
minority populations in Arizona and to identify problems in the
health status of ethnic minorities. To date information on
minority health status is quite limited. Current DHS
seroprevalence studies and surveillance data do not demonstrate the
need for a comprehensive epidemiologic study of HIV/AIDS among
minorities. Seroprevalence studies are in fact being conducted
among clinic populations representing primarily minority
populations. DHS is cognizant of the need for additional financial
and human resources in order to address the prevention needs of the
minority communities. DHS currently provides $157,000 in federal
funds for AIDS education in minority comunities.
DEPARTMENT OF HEALTH SERVICES - OFFICE OF PLANNING AND HEALTH
STATUS MONITORING
Monitors health status trends of Arizona residents with respect to
natality, mortality and morbidity. Of special interest is the
collective population of ethnic minority residents who represented
25 percent of the State's population in 1980 and have grown to
approximately 33 percent in 1990. Available information is limited
but does raise concerns for the health status of ethnic minorities.
A health status perspective of minority health will be expanded by
DHS in order to more fully understand and respond to the special
health concerns of ethnic minorities i